Medical social work is a sub-discipline of social work that addresses social components of medicine.[1] Medical social workers typically work in a hospital, outpatient clinic, community health agency, skilled nursing facility, long-term care facility or hospice. They work with patients and their families in need of psychosocial help. Medical social workers assess the psychosocial functioning of patients and families and intervene as necessary. The role of a medical social worker is to "restore balance in an individual’s personal, family and social life, in order to help that person maintain or recover his/her health and strengthen his/her ability to adapt and reintegrate into society."[2] Interventions may include connecting patients and families to necessary resources and support in the community such as preventive care; providing psychotherapy, supportive counseling, or grief counseling; or helping a patient to expand and strengthen their network of social supports.[3] In short, a medical social worker provides services in three domains: intake and psychosocial assessment, case management and supportive therapy, and discharge planning and ongoing care that extends after hospitalization. They are also involved in patient and staff education, as well as with policy research for health programs.[4] Professionals in this field typically work with other disciplines such as medicine, nursing, physical, occupational, speech, and recreational therapy.
The history of medical social work is intertwined with the history of social medicine. Dr. Richard Cabot, a physician associated with one of the earliest medical social work departments, noted that the active efforts to combat preventable diseases emerged through the actions of social workers. These actions included initiatives like the Anti-Tuberculosis Crusade, the Clean Milk Crusade, the Pure Food Law, the Playground Association, and the School of Hygiene.[5]
Medical social workers in Britain and Ireland were originally known as hospital almoners or "lady almoners" until the profession was officially renamed medical social work in the 1960s. In 1895, Mary Stewart became the first lady almoner in Britain with her appointment to the Royal Free Hospital in London for a three-month trial period. Some sources credit Anne Cummins as the "mother of almoners" as she had the ability and the funding to first establish a comprehensive social work service at St Thomas's Hospital in London in 1909.[6] Lady almoners determined the patient's ability to contribute towards their own medical care at charity hospitals. This approach was also followed by Australia during its vassal period with Great Britain. They adopted an approach similar to strength-based case management, and formal education for almoners was introduced in Australia in the early 1920s to carry out the required tasks.[7]
In 1922, the Institute of Hospital Almoners in Britain was formed. A group focusing on the application of psychology to the treatment of mental illness separated from it and established the Association of Psychiatric Social Workers, largely due to the mental health courses provided by the London School of Economics in 1929. In 1964, two separate professional bodies of Hospital Almoners, one an institute and the other an association, merged to become the Institute of Medical Social Workers.[8] These professional groups later merged with the British Association of Social Workers, which was formed in 1970. In Britain, medical social workers were transferred from the National Health Service (NHS) into local authority Social Services Departments in 1974 and generally became known as hospital social workers.
Medical social work was started in 1921 by Ida Pruitt in Beijing. In-service training was given to social workers for carrying out casework, adoption services and recuperation services.[9]
Dr. Clifford Manshardt an American missionary in 1936 started formal training in social work in India through Dorabji Tata Graduate School of Social Work.[9] The first medical social worker was appointed in 1946 in J.J. Hospital, Bombay. In 1960s scope of medical social workers increased in India.[10]
In Ireland, the origins of medical social work go back to paediatrician Ella Webb, the first physician in Ireland to appoint almoners to work in her dispensary for sick children that she established in the Adelaide Hospital in Dublin, and to Winifred Alcock, the first almoner appointed by Webb in 1918.
Almoners from St Thomas’ Hospital, London, who arrived in Singapore in 1948 and 1949 are recognized as the forerunners of hospital social worker's in Singapore. Medical Social Worker is a Singapore Ministry of Health recognized profession for psychosocial care and a required professional by bylaw in every clinical specialty department.[11] [12] [13]
The Massachusetts General Hospital was the first American hospital to have professional social workers on site, in the early 1900s. Garnet I. Pelton, Ida Maud Cannon and Dr. Richard Clarke Cabot were the central figures of the hospital social work. Clarke credited his approach as similar to that of Anne Cummins in London.[14] The establishment of medical social work services in the United States is attributed to the inspirational and insightful efforts of the Society for the Aftercare of the Insane in England, the reorganization of Lady Almoners' work by C.S. Loch and Colonel Montefiore, the visiting nurses who conducted the final medical tasks of the hospitals, and the social service training Dr. Charles P. Emerson provided to medical students at Johns Hopkins University.[15] Cannon started specific training for medical social workers in 1912. The major duties carried out by medical social workers were case management, data collection, follow ups, care coordination, health education, financial assessment and discounting patient medical fees.[16] However, historically, social workers began engaging independently in the healthcare field much earlier. In 1893, Jane Addams established a medical dispensary at Chicago's Hull House. In 1912, social worker Anne Moore conducted a study on possible dispensary abuse in New York County. This was during a time when the prevailing belief about poverty was that it was an outcome of consequentialism. Moore found that 90% of the patients were deserving of free treatment. A survey conducted in 1976 revealed that half of the directors in federally mandated health planning bodies were social workers, and more than 17,000 social workers provided their services at varying levels in Medicare participating hospitals.[17]