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   Although social work's Progressive era was dominated by the story of the settlements, the practice of social casework also made significant advances. During the first years of the 20th century, social casework diversified. It moved out of the confines of charity organizations and into a variety of fields.


Medical Social Work

   In the 1850s, Elizabeth Blackwell introduced "visitors" into the homes of New York's sick. However, Medical social work did not become an area of practice until Dr. Richard Cabot introduced a medical social services department at Massachusetts General Hospital in 1905.

   Concerned by the hospital's lack of post- hospital care, Dr. Cabot and his colleague Ida Cannon became effective advocates for the introduction of social service departments into medical settings. Seven years after founding the service, a specialty in medical social work was offered by the Boston School of Social Work. A number of hospitals, mainly in the Northeast, established medical social work departments.

Psychiatric Social Work

   The field of psychiatry was receptive to adding social workers to its teams, thereby creating a new specialty in social casework, psychiatric social work. Adolf Meyer, a prominent leader in the mental hygiene movement, believed that psychiatry needed to focus more of its efforts outside the asylum. He identified the social worker as a primary agent in providing a better understanding of the patient's social environment. Beginning in 1902, clinics and out-patient psychiatric departments began to proliferate in the larger urban hospitals. Most of the new services included psychiatric social workers.

Social Service was the agency that reaches into the home and makes it its duty to supervise the conditions outside of the hospital and the activity of the patient in relation with the family and community. ~Adolf Meyer

   New York and Massachusetts experimented with privately sponsored psychiatric social work programs.  These pilot programs  led to psychiatric services in these two states being integrated into the state hospital system in 1913.  By 1920, psychiatric social work was an accepted part of the psychiatric team.  Social workers addressed mental hygiene problems in mental hospitals, outpatient clinics and juvenile courts.

School Social Work

   School social work was closely tied to the settlement movement. In 1906, several New York settlements sponsored "visitors" for three school districts. Under the leadership of Hartley House's Mary Marot the project was so successful that school social work services were added to the city's school system in 1913.
Boston had launched a similar program in 1907. This project too, quickly proved its value and was integrated into the local educational systems. By 1920, school social service programs were functioning in 28 communities as disparate as Boston and Mason City, Iowa. Historian Roy Lubove describes their role:

In theory the visiting teacher dealt with those whom neither the attendance officer, school nurse, or classroom teacher were equipped. The teacher or principal refereed children whose educational experience was obstructed by deficient scholarship, demoralizing home conditions, misconduct, physical defect and similar handicaps. After an examination into the background and personality of each child, the visiting teacher used whatever personal influence or social adjustments were necessary to insure efficient performance. She relied heavily upon casework as her major technical resource.

   By the time America became involved in the First World War, casework had developed as a major force in the new field of social work. No longer regarded as a technique only suitable for private charities serving the poor, casework was identified as a broad skill applicable in a wide variety of arenas including mental hygiene, schools, hospitals, and juvenile courts.

Immigrant families posed special health risks

Adolf Meyer

A disturbed young man finds refuge in a flooded basement

Some schools lacked basic facilities

Early social workers fought to create playgrounds

Adapted from

Special thanks to the late Professor Dan Huff and Boise State University School of Social Work

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