[Oklahoma State Department of Health, Division of Maternal and Child Health] [In cooperation with: The Children's Bureau, Department of Health, Education, and Welfare, Presents] [The Public Health Nurse and the Retarded Child] [A University of Oklahoma Production] [Producer-Director:] Charles N. Hockman [Script by:] Dwight V. Swain [Camera Editor:] Milton Roberts [Coordinator: Jo A. Barnard, R.N., Public Health Nurse] [All children shown as retarded children are retarded] [Music] [Narrator:] For Helen Roberts, public health nurse, it began like any other case, a school referral. An eight-year-old named George Hargrove needed an eye check. Hardly a relaxed type, this Mrs. Hargrove. She's young and she's troubled. But she says George already has an eye appointment, and that's all that matters. Or is that really all, where you as a public health nurse are concerned? [Music] [Loud crash in other room.] [George:] Ow! [Narrator:] Now who might this young man be? Could he have anything to do with his mother's worn, weary, discouraged look? Don't worry, Mrs. Hargrove, all children fall sometimes. Only Mrs. Hargrove doesn't seem to see it that way. Mrs. Hargrove is tired and heartsick. She's exhausted all her own resources. [Music] [Mrs. Hargrove:] Don't expect him to say anything, Miss Roberts. He can't talk. And that flashlight, if you're trying to make some kind of test or something, you're just wasting your time. Mark, well, he's awfully slow about everything. [Music] [Narrator:] It's terrible for Mrs. Hargrove, watching him, hearing the things people say... But she still can't believe he's really hopeless, because you see, she loves her little son. If only she could see a little progress. If only he could learn even the simplest things, like how to dress himself. Hope, learning, progress, that's where you'll come in, Miss Roberts. From you, Mrs. Hargrove can learn the importance of having Mark tested, diagnosed, evaluated... finding out how much he's able to learn. She needs your emotional support, your guidance... needs you to help her understand how much patience and love and ingenuity and effort go into teaching a retarded child. So you're the one to show her how to help her child to learn. You, Helen Roberts, public health nurse. But that's all a long-term project. And right now, you've a child health record entry to make. Detailed observations of behavior to note. Too, you'll have to arrange a referral on this case through proper channels. Draw on your knowledge of state and community resources for care of the mentally retarded. See to it that Mark and his parents get all available help in dealing with their problem. Ordinarily, each nurse will have at least a few retarded children in her caseload. So sooner or later, you'll be working with a retarded child. Often the startle pattern is a good indicator. Check further when a child doesn't react to a sudden noise. A normal child ordinarily shows a marked response. Too, a normal child may be expected to track bright objects with his eyes at an early age. He doesn't sit passive like this baby. Such simple tests as these-- you already know many of them out of your training and experience-- they all help you to tell the normal child from the retarded. When a five-year-old fails to work a two-year level puzzle, it may indicate retardation. A six-year-old should be able to talk intelligibly. If he can't, the problem may be a speech defect, or it may be retardation. On the other hand, a mother may claim that her child is a behavior problem, and try to hide the fact that he's slow or emotionally disturbed. In either case, as in all such situations, your first step is to call the case to medical attention. This case-finding is one of a nurse's biggest jobs where mental retardation is concerned. Because retardation has many, many causes: brain injury, mongolism, cretinism, galactosemia, prenatal factors, familial and dozens of others. With early diagnosis, some cases can be helped medically. But all parents can be helped. to help their youngsters to develop the skills and graces they need to live acceptably with others at their level of readiness. Take feeding. Often retarded children use a four-finger grip, having trouble handling a spoon. Opposition of the thumb hasn't yet developed. Sometimes a bent spoon with a padded handle helps. It's easier for the child to use than one that's straight. It puts his hand in position to grip properly. At first of course, the child may reject the bent spoon. So you have to impress the mother with the necessity for patience. First you show the mother how to proceed, then let her show the child. [Music] No luck? Then go back to the old spoon. And try to teach the child to grip it with his fist. Sometimes the answer is finger-feeding. Teaching the child to drink from a glass helps, too. But do limit yourself to showing the mother what to do. Let her teach the child. [Music] If the child rejects one drink, offer him another. The change may help to overcome his negative attitude. [Music] Repetition, relaxation, and routine. These are the three Rs of the retarded. Together they add up to the kind of help that counts. Toilet problems? Take the child to the bathroom on schedule and there'll be fewer accidents. For heaven's sake, leave a lady some privacy! Oftentimes, play can serve a constructive purpose. To that end, you carry various items for testing and stimulation in your purse. A rattle, a shiny pencil, a flashlight, keys that jingle. You see, we all need reasons for doing things. So you give young Tom a reason to crawl. [Music] Children learn by playing with simple household articles. They enjoy it, too. This is more than just clipping clothespins to a can. This is how Ronald learns to coordinate. Using familiar objects in a real-life situation. Practical jobs help, too. As the child masters the skill, she grows in pride, achievement, and usefulness. The higher-level retarded child can become independent and self-supporting. Social graces are another asset many retarded children can acquire. The trick is to make a game of it. That way the child learns and has fun at the same time. [Music] And so it goes, in home after home. But it's not always the retarded child who claims your attention. Most parents worry about his brothers and sisters, too. What effect does the retarded child have on them? What will happen in the future? As a nurse, you need to give the family emotional support. Help the parents to accept the situation realistically. Build their self-confidence so that they can talk frankly and honestly to their children. Every time you show a retarded child genuine love and affection, you help the mother to become more accepting. Should the child be placed in an institution? Some youngsters will require such custodial care. But often parents don't want to give up their child. And even when the decision is made, it may take months or years to find a place. In the meanwhile, the family can continue to give loving care, and help him to learn what he can. The physician will discuss the factors involved in custodial care as well as care at home. As nurse, it's your job to help the retarded child's parents to understand. Through you, they can come to see the institution and its function in a truer light. You can explain how their child may lead a better, fuller, less complicated life. in a modern public or private school for the retarded. Each retarded child needs a special type of education geared to his mental age. Starting him to school before he's mentally old enough may cause emotional disturbance. It helps, too, when you introduce families to their local council of parents for mentally-retarded children. Give them a chance to discover that they are not alone. That others share their problem. Equally important, you are not alone either. Working together, you and the family physician can screen many retardation cases, though of course it helps if you have a psychologist available to assist you. In Mark's situation, Miss Roberts' first step is to discuss the case with the Hargroves' physician. The community is one of the fortunate few where there's a first-class clinic available. So, the physician refers Mark Hargrove's case there. Here, psychologists evaluate the mental ability of each child, assist in planning for the youngster's present and his future. A child-development specialist checks educational and social abilities, and counsels parents. Physical therapists investigate muscle development and physical coordination. Speech therapists evaluate speech and hearing abilities; recommend therapy when indicated. Occupational therapists give practical training in everyday tasks. The social worker studies family relationships and helps the family use community resources according to their needs. Physicians weigh each individual case and diagnose it. Make decisions, consider treatment. Intake clinics consult with the parents and make a preliminary investigation of the case. [Music] All these contacts tie together, even more tightly, at staff meetings. When the time comes to staff Mark Hargrove, Miss Roberts contributes information and opinion, helps with the evaluation, raises the question of Mark's readiness. From a developmental standpoint, is he really able to dress himself at this time? [Music] Later, the physician summarizes the evaluation from Miss Roberts; advises her as to how to proceed. A meeting between the physician and Mr. and Mrs. Hargrove gives them a clear picture of the medical and emotional aspects of Mark's case. It's important that both father and mother be present. The social worker helps them understand the broader implications of the situation. The public health nurse in turn has continuing contact with the total family. So Miss Roberts decides to work on Mark's dressing problem with repetition, relaxation, and routine. She helps Mrs. Hargrove set up a pattern for Mark to follow: pants, shirt, socks, shoes. Let him put them on in that order every time. Pants with boxer-type waists are easiest for a child to handle. [Music] She shows Mrs. Hargrove how to teach Mark to put on his shirt and button it. [Music] Putting on a sock involves definite procedures. It's best to roll it to the toe and work it up the foot, clear past the heel. [Music] The white stripe here goes right across the toes. [Music] Shoes come next, but learning is a slow process for Mark, so patience is ever the watchword. The same patience and organized effort that helps her in all her work. By adhering to such organized procedures, the nurse finds new cases. She uses all available facilities. She makes proper referrals. She helps with case evaluation. She gives emotional support to anxious parents. Above all she looks for signs of readiness in the child. She shows his parents how to help him learn. How long will that learning take? How far can he go? Nobody knows. The important thing is to start where he is and then keep trying. Don't force. Go at the child's pace. Don't push. Your guides are the small goals. In learning to dress himself, Mark is achieving such a goal. It's one of the few advances he'll ever know, perhaps. But it's an important one in making life easier for him and those about him. [Music] His mother is happy that her child has shown the ability to learn, at least a little. And with that knowledge comes new hope for his mastery of other living skills and social graces. His world has changed. [Music] And our Miss Roberts... Where does she stand? She and every other public health nurse who has helped a family meet this problem? Could it be that she feels an even greater satisfaction than the mother? That in this small triumph, she sees the proof that her work is truly worthwhile. The justification for all her pride and her profession? The fulfillment of her ideal of service? Good questions those, aren't they? Even though for public health nurses, they don't need any answers. [Cast: Nurse Roberts: Marjorie S. Teel, R.N., Public Health Nurse Mark Hargrove: Robbie Edwards Mr. and Mrs. Hargrove: Mr. and Mrs. Jeff Edwards Other Nurses: Staff, Tulsa City-County Health Department] [Film Shot at: Oklahoma Mental Retardation Training Center, Paul S. Benton, M.D., Director. Children's Medical Center, Tulsa, Oklahoma. Sunnyside School for Retarded Children, Tulsa County Council for Retarded Children. Tulsa City-County Public Health Department, T. Paul Haney, M.D., Director. Nursing Division, Combined Nursing Service, Olive H. McDonald, R.N., Director.] [Collaborators: Grady Matthews, M.D., Oklahoma Commissioner of Health. John W. Shackleford, M.D., Director, Maternal and Child Health. Paul C. Benton, M.D., Director, Training Center & Child Psychiatrist. Edythe P. Hershey, M.D., Medical Director Region VII Children's Bureau. Josephine L. Daniel, R.N., Director, Oklahoma Division of Nursing. Rudolf P. Hormuth, U.S. Dept. Health, Education, and Welfare. Julia L. McHale, Ph.D., Child Development Specialist. Lillian E. Whitmore, Ed.D., Psychologist. Gladys K. Dolan, M.D., Pediatrician, Children's Medical Center Robert K. Endres, M.D., Pediatrician. Fred B. Graves, S.T., Speech Therapist. Richard O. Edwards, M.S.W., Social Worker. Stella Spaulding, R.P.T., Physical Therapist. Mabel A. ValDez, O.T.R., Occupational Therapist.] Elizabeth A. Read, Nutritionist. Florence R. Hunstein, Administrative Assistant. Ruth H. Smith, Coordinator, Sunnyside School.] [Distributed by International Film Bureau, Inc.]