A History of Continuity and Change
(November/December 2003)
By Frances Gautieri, CSW, ACSW, Director of Social Work, New York Presbyterian Hospital, Columbia Presbyterian Medical Center
Social work in health care emerged from community roots. Visionary leadership
in the settlement house movement over one hundred years ago led to recognition
of the correlation between illness and social conditions. The Henry Street Settlement
was in the forefront; they began to make home visits to the indigent and sick.
Hospitals began to coordinate with settlement houses and soon developed their
own home visiting programs for discharged patients. At the same time, graduate
social work education was being developed based on the need for better understanding
of the behavioral and social sciences in order to address the problems of individuals,
families, and communities.
The convergence of interest in the psychosocial links to illness and public
health imperatives at the turn of the twentieth century came together to support
the development of professional social work services in hospitals. Early references
to social workers in hospitals confirm the period 1904 to 1907 as the beginning
for the establishment of organized departments of social work. Hospitals in
New York City were among the pioneers including the Presbyterian Hospital, Bellevue
Hospital, and Mount Sinai.* Hospitals soon became the preferred field work site
for graduate social work students.
The public health issues, bio-psycho-social factors, and community conditions
that led to the development of social work in hospitals are paralleled today,
together with new challenges posed by a continually changing health care environment.
The ongoing need for innovative and dynamic social work programs are confirmed
by the scope of clinical practice and therapeutic interventions provided in
all areas of health service delivery throughout the continuum of care. As the
length of inpatient stays continues to decrease and the clinical complexities
of discharge planning is increasingly recognized and appreciated, social work’s
responsibility for liaison between hospital and community is more essential
than ever.
Social work presence in health care is strong especially in urban areas and
academic medical centers. The organization of social work services may vary
by institution but the basic responsibilities remain an integral part of comprehensive
health care. Social workers are also becoming well represented among hospital
management staff as service line administrators, clinic directors, and senior
executives.
The profession’s core values unify and strengthen the efforts of social
workers in health care settings. Social work leadership in developing flexible
intervention strategies, specialized services for high risk groups, and culturally
sensitive programs reflects professional values and supports institutional commitments
to the highest quality health care, service excellence, and responsiveness to
community needs.
*Reference: “The Hospital Survey for New York”, United
Hospital Fund, 1937.