Handbook of Health Social Work
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Handbook of Health Social Work

Sarah Gehlert, Teri Browne

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eBook - ePub

Handbook of Health Social Work

Sarah Gehlert, Teri Browne

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About This Book

The updated third edition of the definitive text on health social work

Thoroughly revised and updated, the third edition of Handbook of Health Social Work is an authoritative text that offers a comprehensive review of the diverse field of health social work. With contributions from a panel of international experts in the field, the book is theory driven and solidly grounded in evidence-based practice. The contributors explore both the foundation of social work practice and offer guidance on effective strategies, policies, and program development.

The text provides information that is essential to the operations of social workers in health care including the conceptual underpinnings and the development of the profession. The authors explore the practice issues such as theories of health behavior, assessment, communication and the intersections between health and mental health. The authors also examine a wide range of examples of social work practices including settings that involve older adults, nephrology, oncology, and chronic diseases such as diabetes, heart disease, HIV/AIDS, genetics, end of life care, pain management and palliative care, as well as alternative treatments, and traditional healers. This is the only handbook of its kind to unite the body of health social workand:

• Offers a wellness, rather than psychopathological perspective and contains treatment models that are evidence-based

• Includes learning exercises, further resources, research suggestions, and life-course information.

• Contains new chapters on topics such as international health, insurance and payment systems, and implementation of evidence-based practice

• Presents information on emerging topics such as health policy in an age of reform, and genomics and the social environment

• Reviews new trends in social work and health care including genetics, trans-disciplinary care, and international, national, and state changes in policy

Written for social work educators, administrators, students, and practitioners, the revised third edition of Handbook of Health Social Work offers in one volume the entire body of health social work knowledge.

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The Foundations of Social Work in Health Care

The Conceptual Underpinnings of Social Work in Health Care

The writing of the first edition of this text coincided with the centennial of the hiring of the first medical social worker in the United States, Garnet Pelton, who began working at Massachusetts General Hospital in 1905. The writing of the second edition five years later coincided with another key event for health social work, namely, the passage of the Patient Protection and Affordable Care Act (ACA) in March 2010, which increased health insurance coverage for U.S. citizens, despite its limitations. This third edition of the Handbook of Health Social Work comes at a time of political strife, when political parties are using the vestiges of the ACA as pawns in a contest for power. Thus, it seems an appropriate time to reconsider the history of social work in health care and to assess the degree to which the vision of its founders has been met in its first 100 years. Ida Cannon (1952), the second social worker hired at Massachusetts General Hospital, whose tenure lasted for 40 years, wrote, “Basically, social work, wherever and whenever practiced at its best, is a constantly changing activity, gradually building up guiding principles from accumulated knowledge yet changing in techniques. Attitudes change, too, in response to shifting social philosophies” (p. 9). How, if at all, have the guiding principles of social work in health care changed over the century, and what can be learned from our examination that will help chart the future of the profession?
This chapter focuses on the development of the profession from its roots in the 19th century to the present. This longitudinal examination of the profession's principles and activities should allow for a more complete and accurate view of the progression of principles through time than could have been achieved by sampling at points in time determined by historical events, such as the enactment of major healthcare policies.

Chapter Objectives

  • Discuss the historical underpinnings of the founding of the first hospital social work department in the United States.
  • Describe the forces and personalities responsible for the establishment of the first hospital social work department in the United States.
  • Determine how the guiding principles of social work in health care have changed from the time of the founding of the first hospital social work department to the present time.
  • Determine how the techniques and approaches of social work in health care have changed from the time of the founding of the first hospital social work department to the present time.
Frequent references to other chapters in this book capture the current conceptual framework of social work in health care.


Social work in health care owes its origins to changes in (a) the demographics of the U.S. population during the 19th and early 20th centuries; (b) attitudes about how the sick should be treated, including where treatment should occur; and (c) attitudes toward the role of social and psychological factors in health. These three closely related phenomena set the stage for the emergence of the field of social work in health care.
A number of events that began in the mid‐1800s led to massive numbers of persons immigrating to the United States. In all, 35–40 million Europeans emigrated between 1820 and 1924. The Gold Rush, which began in California in 1849, and the Homestead Act of 1862 added to the attractiveness of immigration Rosenberg (1967).
About 5.5 million Germans emigrated to the United States between 1816 and 1914 for economic and political reasons. Over 800,000 arrived in the 7‐year period between 1866 and 1873, during the rule of Otto von Bismarck. The Potato Famine in Ireland in the 1840s resulted in the immigration of two million persons during that decade and almost a million more the following decade. Between 1820 and 1990, over five million Italians emigrated to the United States, mostly for economic reasons, with peak years between 1901 and 1920. A major influx of Polish immigrants occurred between 1870 and 1913. Those arriving prior to 1890 came largely for economic reasons; and those after, for economic and political reasons. Polish immigration peaked again in 1921, a year in which over half a million Polish immigrants arrived in the United States. Two million Jews left Russia and Eastern European countries between 1880 and 1913.
The United States struggled to adapt to the challenge of immigration. The Ellis Island Immigration Station opened in 1892 to process the large number of immigrants entering the country. By 1907, over 1 million persons per year were passing through Ellis Island. The massive waves of immigration presented new healthcare challenges, especially in the northeastern cities where most of the new arrivals settled. Rosenberg (1967) wrote that 723,587 persons resided in New York City in 1865, 90% on the southern half of Manhattan Island alone. Over two‐thirds of the city's population at the time lived in tenements. Accidents were common, sanitation was primitive, and food supplies were in poor condition by the time they reached the city. One in five infants in New York City died prior to their first birthday, compared to one in six in London (Rosenberg, 1967). Adding to the challenge, the vast majority of immigrants had very limited or no English language skills and lived in poverty. Immigrants brought with them a wide range of healthcare beliefs and practices that differed from those predominant in the United States at the time.
In the late 1600s and early 1700s, persons who were sick were cared for at home. A few hastily erected structures were built to house persons with contagious diseases during epidemics (O'Conner, 1976, p. 62). These structures operated in larger cities and were first seen before the Revolutionary War. As the U.S. population grew, communities developed almshouses to care for persons who were physically or mentally ill, aged and ill, orphaned, or vagrant. Unlike the structures erected during epidemics, almshouses were built to operate continuously. The first almshouse, which was founded in 1713 in Philadelphia by William Penn, was open only to Quakers. A second almshouse was opened to the public in Philadelphia in 1728 with monies obtained from the Provincial Assembly by the Philadelphia Overseers of the Poor. Other large cities followed, with New York opening the Poor House of the City of New York (later named Bellevue Hospital) in 1736 and New Orleans opening Saint John's Hospital in 1737 (Commission on Hospital Care, 1947). Although called a hospital, St John's is classified as an almshouse because it primarily served persons living in poverty who had nowhere else to go.
By the mid‐1700s, persons who became ill were separated from other almshouse inhabitants. They were at first housed on separate floors, in separate departments, or other buildings of the almshouse. When these units increased in size, they branched off to form public hospitals independent of almshouses. Hospitals eventually became popular among persons of means, who for the first time preferred to be treated for illness by specialists outside the home and were willing to pay for the service.
A number of voluntary hospitals were established between 1751 and 1840 with various combinations of public and private funds and patients' fees (O'Conner, 1976). The first voluntary hospital was founded in Philadelphia in 1751 with subscriptions gathered by Benjamin Franklin and Dr. Thomas Bond and funds from the Provincial General Assembly of Philadelphia. The New York Hospital began admitting patients in 1791, and the Massachusetts General Hospital in 1821. In 1817, the Quakers opened the first mental hospital, which began admitting anyone needing care for mental illness in 1834.
A third type of medical establishment, the dispensary, began to appear in the late 1700s. Dispensaries were independent of hospitals and financed by bequests and voluntary subscriptions. Their original purpose was to dispense medications to ambulatory patients. In time, however, physicians were hired to visit patients in their homes. The first four dispensaries were established in Philadelphia in 1786 (exclusively for Quakers), New York in 1795, Boston in 1796, and Baltimore in 18...

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