The Social Work-Medicine Relationship

100 Years at Mount Sinai

Helen Rehr, Rosenberg Gary

• Publisher: Routledge
• Year: 2012
• Print ISBN: 9780789030764
• eBook ISBN: 9781135801830
• Topic: Medicine
• Subtopic: Health Care Delivery

An absorbing exploration of the growth of social work at the Mount Sinai Medical Center

The Social Work-Medicine Relationship: 100 Years at Mount Sinai explores the lessons learned in the formation and management of social work departments in health care, through the perspective of the hospital internationally acclaimed for excellence in clinical care, education, and scientific research. Internationally respected experts Dr. Helen Rehr and Dr. Gary Rosenberg from Mount Sinai use their unique viewpoints to tell the extraordinary story of a century of knowledge and growth, concentrating on the development of the social work department and the people dedicated to providing the finest care possible. This commemoration of the winding path of social work and health care takes the reader on a fascinating and surprising walk through the history of not only a great hospital, but also the effects that the work at Mount Sinai had on the community and public policy.

The Social Work-Medicine Relationship provides an absorbing general history of social health care and its growth at the Mount Sinai Medical Center from its inception in 1906 to the present day. This unique review of the factors in place that triggered the formation and subsequent growth of the institution's social work services department is useful knowledge for every social worker in both academic and practice organizations. Special focus is given to explain how women have consistently been a driving force in the expansion to fulfill the needs of the community. Presentation papers are included from influential women the first half of the century that illustrated patient needs and positively affected the growth of services. The book is extensively referenced and includes several informative appendixes.

The Social Work-Medicine Relationship explores the history of:

• early medicine
  
• social services
  
• American medicine and the emergence of the social work profession
  
• the beginning of Mount Sinai medicinethe Jews Hospital
  
• the Mount Sinai Auxiliary Board
  
• Mount Sinai's Department of Social Work Service
  
• applied social work research
  
• the Mount Sinai Department of Community Medicine
  
• the Mount Sinai Division of Social Work
  
• globalization of social work services
  
  

The Social Work-Medicine Relationship is engrossing reading for social work scholars, historians interested in the history of social work in medicine, directors of departments of social work in health care organizations, and educators and students of social work.

Chapter 1
Introduction: Social Work Services in Health Care: The Challenges

Social work, the profession, is being pulled in many directions. As social work developed, finding new and essential roles and functions in multiple fields, the profession took on many modes. Over time the clinical and social policy arenas separated (as did medicine from public health), and the academics and the practitioners did not find unity. As each division tended to serve itself, the result was professional separation rather than togetherness. In addition, the incursion of behaviorists and nurses into counseling roles, interprofessional turf conflicts, deprofessionalization, and the commercialization of health care services have led to an uncertainty in social work roles and direction. But the major impacts come from the unpredictability of fiscal support for the social services, from the still uncertain status of social work in health settings, and from a continuing lack of social work visibility and understanding of its benefits by the public, administrators, payers, and regulators.

The current economic crisis is affecting the employment market, the social welfare system, health care services, and education for professional practice as a result of severe cutbacks in support by government and private insurers for service delivery. In addition, government support of public social-health policy has been eroding in the last decade. The health care insurance companies have either not incorporated social service benefit into their policies or have limited social services benefits. Another drawback is that social work has not transmitted an adequate message of its benefits and its availability to those in need in health care and to those who are vulnerable in coping with illness and/or disorders, irrespective of economic status.

Those in low-income groups and those in poverty are generally perceived by the public based on the country’s economic status. When the country is affluent, the populace tends to be more generous in offering help to those in need. When the country is fiscally unstable, the populace believes the poor should help themselves. It appears that economics governs the availability of accessible medical care as well as health care social services. What is essential is a social-health policy regarding the “right to health care” and affordable comprehensive care. Although social work is responsible for the majority of mental health counseling services to those with biopsychosocial problems, the profession as organized in social or health agencies has not made its benefits sufficiently known to cause a public demand for social work services and for the support for serving those with social-health needs. Conservative beliefs about the moral causes of poverty affect public policies and lead to increasing numbers of persons in the United States who are uninsured or underinsured. Emphasis is still placed on illness, and very little attention is given to support primary prevention and health promotion throughout the life cycle.

In addition, most people agree that the current American health care delivery system is bleeding. The past two decades of cost containment, competition, and deregulation have barely controlled the hemorrhaging of a system that may be the world’s most sophisticated yet still costs too much and does not serve all who need care. American health care is a paradox of excess and deprivation. Excess occurs when people with comprehensive health insurance receive unnecessary and inappropriate health services. Deprivation occurs when those who are poor and those without insurance or with inadequate insurance are denied care. After the debacle of a prospective universal health care policy in the 1990s, politicians may again be interested in responding to the public’s concern about the rising cost of medical care and its quality.

We have come from a century in which vast changes have occurred. From its beginnings of a nonmedical care system in America and the country’s early social tumult, we have seen the development of a medical care system, a public health system, and a social welfare system amid tumultuous waves of economic growth and temporary declines. The 1900s have also spawned the development of American social work as a profession. In the latter half of the twentieth century, those whose social work life span is included in this period have seen societal needs and expectations impacting the health care system and its practitioners. The development of new organizational arrangements, technology, and enhanced medical and surgical practices have also changed the delivery of care. Yet, with all the advancements, more in the twentieth century than in all prior centuries combined, neither government nor science has resolved the ongoing problems relevant to disease, hunger, poverty, and those surfacing today such as AIDS, abuse, and violence and their impact on individual and family life.

Although there have been major advances and an improved public health system as we have entered the new century, the current government has moved to diminish its support of the means to the “right to health care” of its citizens. Inequality in availability, affordability, and access to care remains, as it affects different groups: those with low income, minorities, noncitizens, and the homeless. In shifting the political direction from social-health care as a public social utility to commercialized enterprises, the balance of power and planning has moved to a corporate presence exercising medical determination. The shift has reduced the availability of professional diagnosis and treatment and social-health care for many and has placed the burden of responsibility for support and care on the individual person and his or her social network with less help and professional assistance.

While many of the social-health problems of the past century remain today, many gains have affected medical care that need to be recognized and that affect social work in health care. Some of these gains include the following:

• a provision of patient’s rights in his or her medical care;
• informed consent as an essential component of care;
• the scientific and technological advances that have dealt with diseases and other treatments;
• the enactment of multiple health insurance programs, e.g., Medicare, Medicaid;
• the development of rehabilitation medicine;
• a biopsychosocial approach to dealing with illness and disorders;
• a social-health model of care versus a medical model;
• a lay public participation in medical institutional programs, initiated by the Model Cities Act;
• peer review and accountability of quality care;
• legalization of abortion, as a woman’s right;
• the growth of consumers’, women’s, and the civil rights movements;
• end-of-life decision making as an individual determination;
• self-help groups to assist individuals with specific diseases;
• the development of national organizations and foundations to deal with disease/disorder entities; and
• the use of the Internet as a health-informative tool, which reduces professional consultations.

Health care has shifted from an essentially voluntary, insurance, employer-employee benefit and government-supported system to a deregulated, competitive commercialized enterprise. Today’s managed care and commercial insurers with their capped benefits and prescribed cost reimbursements tend to be cost control and profit oriented organizations. Prevention and health maintenance coverage is rarely included in their policies. Public health services remain under-funded and lacking in direction. Health care is focused on illness treatment and limited on prevention. There is not enough emphasis on the populations at risk and the health needs within given communities.

It is today’s health care, its availability, affordability, and quality that remain the public’s concern. The beginning of the new century introduces a health care delivery system in crisis. It is difficult to predict the future in meeting the social and health care services needed and in making available an affordable and accessible care system for all Americans. The key concerns are what care will be available, “who” will provide “what,” and “how” will care be paid. We enter the twenty-first century recognizing the past and knowing much remains to be done to create a comprehensive social-health care system with affordable service coverage. It will require a multiprofessional force supported by quality education of the different disciplines.

Is there meaning today in writing a history of medicine and the social work connection? If one looks at the history of medicine, one sees the different means of supporting the sick in early times by tribes, societies, and the church as well as some of the horrific dealings such as eliminating the sick. However, whatever emerged over time, charitable help was in evidence from the beginning of recorded history.

Many years ago, one of the authors sat in a class given by Dr. Albert Lyons on the history of medicine. She then read the Lyons and Petrucelli book Medicine: An Illustrated History and looked for a comparable illustrated history of the social services (or their equivalent) and could not find any similar approach to social work’s past. In the 1940s, having done a history of medical education and social work’s role for class, that exercise whetted her curiosity about social work’s past. After all these years, we started to look back.

What the authors have attempted is an overview of medicine past and present and how social work and committed women have connected to medical care, its institutions, and the health needs of populations at risk. It reflects on the authors’ views, each looking back after fifty and thirty years in the social services in one medical center. Such looking back and ahead is colored by personal, professional experiences in an organization that has undergone multiple leaderships and changes over fifty years—the latter half of the twentieth century and into the beginning of the twenty-first century. In touching on the past, the authors have generalized to given historical periods, reflecting on the relationship of the social services to medicine. In a way social and environmental support for the sick has been available from the beginning of the practice to aid the sick. (See Kerson, 1981, for the relationship of societal work and social events.)

Much has happened in the field of medicine. It has advanced with more medical innovations during the twentieth century than in all past centuries combined. Yet medicine remains on the cusp with more to conquer. Although many diseases and disorders may be tempered by research, innovation, and public health measures, much of what exists today in the way of disease and disorder is expected to be at least into the next twenty-five years. The way people use professional medical care is changing. Although more partnership occurs between patient and physician, there is more use of technology via the Internet. A mountain of information is available on the Internet— freely available. The concern remains as to how to make its use sound and safe as long as interpretation and consultation services are lacking or not utilized.

The authors have decided to introduce the development of social work services and medicine in one academic medical center in reflecting on the gains and the losses. In so doing they hope to portray the social work relationship to medicine over a fifty-year period in an attempt to demonstrate the accomplishments gained in serving its patients and its community. Quality leadership, visionary laywomen, administrative groups, and fiscal responsibility led to innovations in comprehensive care, which shaped a model of social-health care replacing the traditional medical model of service. Many advances served to fulfill the institution’s missions. One example is the relationship of social work and medicine.

In the past ten years societal changes—social, medical, political, demographic, and economic—have been many. They have affected the patterns of medical care in the institution where these authors served in practice, administrative, educational, and research roles. The fiscal impact on health care has had a negative effect on the quality, the availability, and the access of care for all prospective clientele. Institutions across the country have been forced to cut back on their programs. The public is aware of the problems in the delivery of quality health care and has registered its concern about the medical care available to it.

The changes have undoubtedly influenced our perceptions of the past and of today’s events and led to speculations on tomorrow’s American social-health care system.

Will there be a universal comprehensive social-health care policy with entitlements for all Americans? Will social work be active in providing services and in advocating for a social-health policy for those in need?

Chapter 2
Early Medicine and the Social Services

Social work is in a sense “ancient history.” Medical history offers social work in health care a perspective on what people undertook in caring for those with social-health needs. Sufficient evidence indicates that disease existed in prehistoric times. Archaeological finds of human remains suggest evidence of fractures, inflammation, and other physical irregularities. The question that has been posed by anthropologists is “was there a cult of healing” to deal with these recognized anomalies. As humans moved from “food gathering” to “food producing,” there appears to be indication of the development of medicinal herbs. It is known that spiritual ritual—culturally based—was a significant factor toward treating ailments. However, much of caring in early times appeared to be self-directed.

As primitive cultures have been studied, the supernatural was believed to affect all things. Humans separated their daily, ordinary practices and conditions from those that appeared to be different and unusual, as induced by “evil” forces. These latter required special assistance from a medicine man, a shaman, or a witch doctor. The individual afflicted and the healer perceived a supernatural causation. They were together in being “psychologically” invested by a magic to deal with the trauma (Lyons and Petrucelli, 1978, p. 3). Different cultures had different perceptions for the course of illness, sickness, disability, and mental illness, ranging from good to bad spirits. Some acted by shunning the afflicted and others by killing off the disabled or the old.

There were those who were “healers” who ministered to the sick. Healers could have multiple functions such as protecting the harvest or inducing a special event, or they could be specialized dealers for given symptoms and ailments that affected a body part. Illness was seen as caused by gods, spirits, and magic affecting the individual who it was believed brought the affliction on himself because of mis-deeds. A history of the “happening” related to the problem was the instrument used by the healer in order to mitigate the affliction. The healer’s armamentarium could include medicinal plants, hallucinatory drugs, salves for infections, and even a form of surgery to deal with wounds or injured bones. Over time, trial and error of treatments led to further use of mineral substances and even to the use of “heat” for given conditions. What was most significant was the recognition by those entrusted with the healing function that a “psychological” benefit was induced in the sick by the very act of doing something. Magic was the cure for supernatural causes. Observation by healers led them to recognize that some conditions did not strike twice and to understand that certain conditions self-healed. As observations increased and were shared, it was noted that given conditions were frequent occurrences. Some cultures introduced common means to deal with given conditions such as public health measures, e.g., the introduction of latrines and the drainage of wastes.

As early as 1700 BC in ancient civilization, there is a record of the regulation of the practice of medicine (Lyons and Petrucelli, 1978, p. 59). Illness was still perceived as supernaturally imposed, but it was now attributable to sin or misdeeds. Prayers and sacrifices were the common religious means to assuage the gods in seeking cures. Medicines were already in use and noted for given conditions. The healers were now classified by function and/or beliefs. There were those who “diagnosed” (symptoms only) and those who “treated”; exorcists were healer-types who used charms, divination, drugs, and even surgery (Lyons and Petrucelli, 1978, p. 67). Healers were educated in priestly temples. Symptoms had begun to be classified, not as diseases but based on their location, e.g., chest, abdomen. By this time, there was a separation of care for the rich undertaken by these priestly healers and for the poor by the equivalent of barbers.

The biblical Hebrews held the belief that disease was “divine punishment” for a committed sin. The Hebrews differed from other sects in that their beliefs were monotheistic rather than polytheistic or spiritual. The Bible and the Talmud offer a rich medical lore influenced by the Greek philosophers who had some knowledge of anatomy and physiology and who used diet, drugs, massage (Lyons and Petrucelli, 1978, p. 72), surgery, and bloodletting. The mores required one individual to serve another in times of need. Organized religion fostered this concept in the broad application of brotherhood and “serve thy neighbor.” The Hebrews added a form of public health to their doctrines, which included dietary practices and cleanliness. Although immersion was considered a means of purification from sin, it was also a factor in cleanliness. The early Christians adopted baptism by rites of immersion (from Hebrew law) as early as the first century (Cahill, 1999, p. 122). Other early documentation included “teaching” materials, a sort of regulation of medical to-dos.

It is not known when hospitals as such were designed. Some evidence suggests that types of dispensaries with specific functions, such as for maternity care in ancient India, were in place as early as the third century BC (Lyons and Petrucelli, 1978, p. 119). In ancient China evidence supports that prevention was a major practice. Such factors as temperance, simplicity in lifestyle, and sexual mores were philosophically prescribed. Diagnosis was based on both physiological examination and explicit learning about the patient from the patient. Treatment of illnesses included medicines, acupuncture, and exercise, but could also include foot binding, castration, and a variety of divinely prescribed modalities.

As hospitals were created, they were more like hospices for the sick poor, staffed by priest-physicians. Upper-class individuals when ill were also treated by priest-physicians, but essentially at home. In China, there was a sort of “accountability” system wherein doctors had to report both successes and failures (Lyons and Petrucelli, 1978, p. 141). A ranking as to quality levels was developed and publicly known by the elite. Chinese medicine was well developed early, including schools for medical education. The education for medical practice moved to the East as early as the seventh and eighth centuries. Personal examinations were required in order to qualify to be a physician as early as the seventh century AD (Lyons and Petrucelli, 1978, p. 141).

In Greece, while the gods were thought to induce illness, there was evidence of knowledge of anatomy and physiology competing with superstition. The Greeks introduced the tenet that a “life force” emanated from inside the body and also that the “psyche” was “the soul or individual personality” (Lyons and Petrucelli, 1978, p. 154). The Greeks created “temples” or “spas” associated with dealing with illness and also to support health maintenance. Programs included diet, exercise, divination, medication, immersions, and magic. The key catalyst, however, was “faith” as the curing medium. “Health” spas live on today with the same objective.

While information for caring for sickness was passed on orally by itinerant craftsmen, school...

Table of contents

• Cover
• Title
• Copyright
• CONTENTS
• Foreword
• Chapter 1. Introduction: Social Work Services in Health Care: The Challenges
• Chapter 2. Early Medicine and the Social Services
• Chapter 3. American Medicine and the Emergence of the Social Work Profession
• Chapter 4. Mount Sinai Medicine and the Women Who Socialized the Institution
• Chapter 5. Social Work Activist-Leaders: The Making of a Social Work Department
• Chapter 6. Social Work’s Past Shapes the Present
• Chapter 7. Social Work Research in Health Care: Studies That Affect Practice
• Chapter 8. Community Medicine and the Social Work Connection
• Chapter 9. The Globalization of Social Work Services in Social-Health Care
• Chapter 10. Medicine and Social Work: The Social-Health Challenge
• Appendix I. Directors, Department of Social Work Service
• Appendix II. Edith J. Baerwald Professors of Community Medicine (Social Work) and Chairpersons, Division of Social Work and Behavioral Sciences
• Appendix III. Chairpersons, Auxiliary Board
• Appendix IV. Social Work Events
• Appendix V. Auxiliary Board Projects, 1969 to 2004
• Appendix VI. Women As Volunteers
• References
• Index