Development of Medical Social Work in UK, USA, India and Bangladesh

Historical Background of Hospital /Medical Social Work: Global Perspective

Nowadays, medical social work is considered a specialised branch of Social Work and an integral part of the medical team. The present status of medical social work has not been achieved overnight. It has taken a long period to reach its current level. During the nineteenth century, significant scientific progress was made in medicine. The germ theory of disease and the organic approach to the diagnosis and treatment of disease contributed in no small measure to the beginning of a scientific ear in medicine. With the significant advance in the development of a scientific body of knowledge and the discovery of several mechanical aids for diagnosing and treating illness, specialisation and institutional medical care became inevitable. 

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In the early twentieth century, social work established itself as a vocation committed to major social reform, social change, and poverty eradication. Over time, it shifted from religious and charitable practice to a more systematic, professional one. Social service moved from a privately funded volunteer activity to a publicly funded, paid occupation.

Britain and Ireland are the first nations that acknowledged the need for Medical Social Workers to extend clinical care in administrative and support aspects. Medical social workers in Britain and Ireland were previously known as Almoners or Hospital Almoners. They were competent personnel of education and refinement who could consider and screen the position and circumstances of patients. In Ireland, the origins of medical social workers go back to Dr. Ella Webb, who, in 1918, established a dispensary for sick children in the Adelaide Hospital in Dublin, and to Winifred Alcock, who trained as an Almoner and worked with Dr. Webb in her dispensary.

In 1945, the Institute of Almoners in Britain was formed, which, in 1964, was renamed the Institute of Medical Social Workers. The Institute was one of the founder organisations of the British Association of Social Workers, 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.

In the United States, Richard Clarke Cabot in Massachusetts General Hospital created the position of Hospital Social Worker or Medical Social Worker in the early 1900s. This was important from an epidemiological point of view, as it made it easier to control and prevent outbreaks of syphilis and tuberculosis. The prestige of social work rose up in the USA with war-related activities such as the Red Cross home services.

The earliest forms of social work activities were started in India. In ancient India, the nature of social service was that of charity. Mutual help and reciprocal relationship were very high in the community. People believed that "to serve man is to serve God" (Manav Seva Madhava Seva). People were encouraged to practice the virtue of Dana. Dana was treated as a way of purifying the soul of alms-givers, and it was a great relief to both the giver and the receiver. The Rig Veda (Chapter 1 XIII, 2) encourages charity by saying, "May the one who gives shine the most". Upanishad prescribed that every householder must practice charity. Bhagavat Gita insisted that the privileged class has a moral duty to serve the poor. Christian missionaries introduced modern social work in India at the beginning of the 19th century, which was later strengthened by Rajaram Mohan Roy, Ishwar Chandra Vidyasagar, Sasipade Banerjee Sayyid Ahmed Khan, Gopal Krishna Gokhale, Jyotirao Phule and Dhondo Keshav Karve. In 1905 by the efforts of John Morely, provisions were made for special care for the mentally ill through psychiatric social workers. The formal training in social work was started in India in 1936 by Clifford Manshardt (Missionary) and J.M. Kumarappa (Academician) at Dhorabji Tata School of Social Work (Now TISS) in Mumbai. The significant associations of social work are NAPSWI (National Association of Professional Social Workers in India) and ISPSW (Indian Society of Professional Social Work). India is a signatory to the Alma Ata Declaration and has adopted WHO's principles. In 1945 Bhore Committee Report strongly recommended the appointment of medical social workers in hospitals. The earliest records show that the first medical social worker was appointed in 1946 in Bombay in JJ Hospital. In the 20th century, the Government of India had legislated that every hospital should have a medical social work department able to cater to various needs of the patients and later extended this requirement of a trained social worker in psychology and related fields within schools.


Hospital Social Work in the United Kingdom

In the beginning, hospital social workers were known as Almoners in Britain and Ireland. The credit of introducing hospital social work in Ireland goes to Dr. Webb and Winifred Alcock. Dr Ella Webb established a dispensary for sick children in the Adelaide Hospital in Dublin. Winifred Alcock was trained as an Almoner and worked with Dr. Ella Webb in her dispensary.

In 1885, the necessity of hospital social work practice was felt for the first time in England. Then it was recognised that discharged patients of the mental hospital need aftercare in their homes to escape recurrence of the illness. Physicians realised that recently released patients are coming back to the hospital as they face problems in their living environment. It was felt that these patients needed help to solve their socio-economic crisis that hindered the typical recovery of their illness (Dastur, 1974; Ismail, 2005).

In Britain, professional hospital social work began its journey in 1945 by establishing the Institute of Almoners. It was renamed the Institute of Medical Social Workers in 1964. The Institute of Medical Social Workers played a vital role to form the British Association of Social Workers in 1970 as of the founder organisations. In Britain, Medical Social Workers were transferred from the National Health Services (NHS) into the local authority Social Service Department in 1974. From then, they became known as Hospital Social Workers.


Development of Hospital Social Work in the United States

In the United States, social work practice was based in the community till the early 1900s. In the mid-1800s, social workers dealt with public health problems such as tuberculosis, infant mortality, syphilis, polio and unmarried pregnancy through joint ventures with different agencies (Nacman, 1977, Ross, 1995). Some women physicians, such as Elizabeth Blackwell and Rebecca Cole, played an essential role in the development of social services. Elizabeth Black Well formed a dispensary that developed into the New York Infirmary for women and children. Rebecca Cole, an African American physician, became a sanitary visitor in 1866 (Ross, 1995). In 1893 Jane Addams established a medical dispensary at Hull-House Settlement. But social workers were not permitted in hospitals before 1900 except in a few isolated cases such an event took place City Hospital transformed into the hospital from Almshouse in 1891. Fred Goldenbogen of the Cleaveland City Welfare Department was assigned to set up records at City Hospital so that patients could be identified by name and relatives could be notified in a can of death (Wagner, 1957, Ross 1995). In 1900, William Kerry, director of the City Outdoor Relief Department, assisted the hospital in clearing wards "clogged by chronic patients and by homeless civil war veterans," He also demonstrated the value of social services in the hospital freeing beds(Ross,1995).

Medicine and social work joined lands in 1905 with the establishment of Medical Social Work at the Massachusetts General Hospital in Boston under the enthusiastic, able encouragement of Dr Richard Clarke Cabot. He and others recognised the need to understand more about social factors related to illness and its treatment and utilise social and community resources (Skidmore and Thakery, 1964). Almost at the same time, hospital social work was introduced to three other hospitals; Bellevue Hospital in New York, John Hopkins Hospital in Baltimore and Berkeley Infirmary in Boston (Friedlander, 1982; Ismail, 2005). 

In 1905, at the Massachusetts General Hospital, Miss Garnet Pelton and 13 volunteer assistants were permitted to set up tables and chairs in a corridor known as "the corner "(Canon, 1957, Ross, 1995). This hospital expanded its social services to include forty-five social workers. The first organised department of Hospital training. She worked Dr. Cabot's infirmary from 1906 and on inpatient wards beginning in 1919 (Canon, 1957; Ross 1995).

The American Association of Medical Social Workers (AAMSW) was established in 1918 to support and strengthen the Embryonic Development of Hospital Social Work. This association focused on developing a knowledge base, undertook a series of practice studies, and set a standard for scholarship (Ross, 1995). 

In the mid-1920s, the American Hospital Association (AHA) produced the first formalised articulation of Medical Social Work. By the time, the Social Work department was established in 300 Hospitals. By 1930 the number of Hospital Social Service Department increased up to 1000. By 1946 a total of 2095 Social Workers belonged to the American Association of Medical Social Workers (AAMSW) (Skidmore and Thekary, 1964). 

The conception about the role of Medical Social workers, defined by Richard Cabot, was expanded. Two additional roles were defined: (i) To serve as a liaison between physicians and patients and between physician and community resources required for extra care and (ii) To enlist cooperation with the medical treatment plant through patient's education (Caputi, 1978; Ross, 1995). 

Demand for Medical Social workers increased with the passage of the Federal Emergency Relief Act of 1933, the Federal Security Act of 1935 and the establishment of the Federal Crippled Children's Services, which included social work services (Nacman, 1977; Ross, 1995). 

In 1955, the American Association of Medical Social Work and other social work organisations established the National Association of Social Workers (NASW). The Medical Social Work section of NASW has remained active in the practice and education of Medical Social Work. It has sponsored regional Institutes to raise the level of training in medical settings (Skidmore and Thekary, 1964).

In 1961, the Joint Committee of the American Hospital Association and the National Association of Social Workers formalised additional functions: assisting the health care team in understanding the significance of social, economic, and emotional factors; helping the patient and family to understand these factors to enable them to make constructive use of medical care and promoting their well-being and morale, and assisting the hospital in giving better patient care (advocacy) (AHA, 1961; Caputi, 1978). In the 1960s, theorists such as Perlman, Parad, and Kaplan suggested that the individual with an illness could be understood to be facing a series of adaptive tasks with a capacity for renewal, change, and growth (Mailik, 1979). 

The role of social work in hospitals during the 1950s and early 1960s was expanded and affirmed; consequently, there was a shortage of professionally trained practitioners (Heyman, 1962; NASW, 1959). The need for social work in hospitals was emphasised by chapter xviii and xix of the Social Security Act. Based on the active health insurance for people over 65 years of age (Medicare); for medically indigent people younger than 21 years, permanently and totally disabled and medically disadvantaged people between 21 and 60 years of age and for the medically needy people older than 65 years ( Marcus, 1987; Nacman, 1977; Ross, 1995). In 1960 hospital social workers became involved in social action and emphasised eliminating the external causes of psychological and social dysfunction (Lurie, 1984; Ross, 1995). The American Hospital Association (AHA) was renamed the Society of Social Work Administrators in health care in 1993 (Ross, 1995).


Hospital Social Work in India

The introduction of Hospital Social Work in India was influenced by the work of lady almoners of Britain and medical social workers in America. The physicians of India who visited Britain and America for study got the opportunity to observe the activities of almoners and medical social workers. After returning to India, some physicians were very interested in starting similar activities in their hospitals or clinics. The opening of social and preventive medicine departments in medical colleges, a psychiatric clinic in some of the general hospitals and training programs in medical social work in some of the schools of social work in Bombay and Delhi placed students for practical training in hospitals and clinics give further impetus to the development of medical social work in India. The first medical social worker in India was appointed in 1946 in the J. J. Hospital in Bombay. Gradually, the medical social worker began to be established in other hospitals and clinics of India. At present, medical social workers are working in almost all the States of India (Pathak, 1961). 

In short, hospital social work practice emerged in U. K and USA. Some significant steps can be identified in the development of Hospital Social Work. The first step was recognition of aftercare of patients of mental hospitals and appointment of visitors to avoid recurrence of ill near. The second step of developing medical social work was the appointment of lady almoners in English Hospitals. The step was the practice of visiting patients' homes by visiting nurses. The fifth one was the training of medical students in social agencies. The sixth step was establishing a medical social work department in Massachusetts Hospital in Boston in 1905. The seventh step was the establishment of the American Association of Medical Social Workers (AAMSW) in 1918. The last and most crucial step was the establishment of the National Association of Social Workers (NASW) in 1955. Since its inception, its medical social work unit has been working to date on the development of Hospital Social Work globally.


Hospital Social Service Programs in Bangladesh

After the India Pakistan division in 1947, East Pakistan (present Bangladesh) experienced multifarious refugee problems. To solve these problems, the then East Pakistan government asked for support from United Nations. UN sent a specialist team to Dhaka to help the government of East Pakistan. The specialist team suggested introducing social work to combat these problems. According to their recommendation, a short course of three months on social work was taught in 1953 to produce skilled social workers. In connection to the introduction of Social work, the Hospital Social Services Program was introduced in Dhaka Medical College Hospital in 1958, under the National Social Welfare Council. This program has been expanded up to 88 hospitals in 64 districts under the direct supervision of the Department of Social Services (DSS), Ministry of Social Welfare.

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