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Pioneering a profession: A history of social work innovation at

the MGH, 1905 - 2005

1869

The Ladies Visiting Committee, strong supporter of Social Work

1892

The Vincent Club, strong supporter of Social Work

1904

National Average Wage in the U.S. is 22 cents an hour

1904

The Boston School of Social Work opens, Simmons College

Pioneering a profession: A history of social work innovation

at the MGH, 1905 - 2005

1906 PRACTICE: Main Divisions of Work

1. “Tuberculosis”

2. “Hygiene teaching”

3. “Infant feeding and the care of delicate children”

4. “Vacation, outings and convalescent homes

5. “The care of unmarried girls, pregnant, morally exposed or feeble minded”

6. “Help for patients needing work or a change of work”

7. “ Provision and provisions for patients dumped at the hospital”

8. “Assistance to patients needing treatment after discharge”

1905 FIRST SOCIAL WORKER: Garnet Pelton, a nurse, is hired

by Dr. Cabot, using his own money, to see patients in the Clinics. Due to her illness (tuberculosis),

she leaves six months later.

The West End, circa 1906

1906 EPIDEMIC: Tuberculosis

Tuberculosis is “everywhere.” Volunteers are recruited to supervise educational classes and to refer patients to agencies,

1905 DECISION: Initiate Social Services

Richard Cabot, MD, decides to bring social services to his clinic patients. Purpose: “to make medical care effective” by addressing basic needs of poor patients.

1846

Ether, the first anesthetic used in surgery

1821

MGH admits its first patient

1898

Dr. Richard Cabot named Physician to Outpatients

1905 OFFICE SPACE: “The Corner”

“A few small tables, chairs, a bench and two white screens to give some privacy were the furnishings.”

1912

Dr. Cabot writes Social Service and the Art of Healing

1912

Children’s Bureau established

1913

Ida Cannon writes Social Work in Hospitals

1908

Henry Ford introduces the Model T Ford

1909

MGH neurologist, Dr. James Putnam, brings Freud to Clark University, Worcester

1907 ADVOCACY: Patient Hunger

At request of social workers, hospital opens clinic lunch counter to ease patients’ hunger during long waits to see physician. Milk, crackers and cheese cost 5 cents.

1907 FIRST SOCIAL WORKER: “Sex Problems of Girls”

Mrs. Jessie Hodder is hired to work with unmarried pregnant girls. Her premise: “We must meet them where they are.” In 1911, she leaves to become the Superintendent of the Massachusetts Reformatory for Women in Framingham.

1909 ORGANIZATION: Supervisory Committee

Supervisory Committee formed to oversee and finance the work of this new “non-medical” department. Committee members are: Drs. Richard Cabot, Daniel Jones, Robert Osgood, James Putnam; Ladies Visiting Committee: Mrs. Nathaniel Thayer; Boston School for Social Work Director: Jeffrey Bracket; MGH Superintendent, Dr. Frederick Washburn.

1910 PRACTICE: Medical and Social Diagnosis

Physicians increasingly use Medical Diagnosis as their practice incorporates more scientific thinking. Cannon proposes the use of Social Diagnosis to link social work

1907 PRACTICE: Referring Patients

The process is known as “steering, shoving and following-up.”

1907 DECISION: Cabot Hires Cannon

Ida Cannon, RN, completes 8-month course at Boston School for Social Work, during which time she volunteers with G. Pelton and Dr. Cabot in the Clinics. Cabot hires Cannon. Shortly, she is named Head Worker with five staff and 30 volunteers.

1907 PRACTICE: “Methods of Psychiatric Work”

• “Establish a friendly relation with patient”

• “Encouragement”

• “Suggestion and persuasion”

• “Home visits and letters”

• “Re-education and explanation” and activities like the Clay Modeling Class and “country vacations”

1908 OFFICE SPACE: “The New Corner”

Sign above desk reads: “DO NOT LOSE YOUR BLUE CARD”

1908 PRACTICE: Referrals to Social Service

1916

World War I begins

1917

Mary Richmond writes Social Diagnosis conferring with Ida Cannon

1918

Ida Cannon is instrumental in organizing the American Association of Hospital Social Workers

1920

19th Amendment passed, women get the right to vote

1910 ANNUAL REPORT: Patients seen = 1709

General work: 50% Tuberculosis: 35% Nervous Disorders: 9% Unmarried Girls: 6%

1911 FIRST SOCIAL WORKER: Handicapped

Kings Chapel, in Boston, pays for social worker to provide services to the handicapped. She works at both the Clinics and at Kings Chapel.

1911 FIRST SOCIAL WORKER: Children’s Clinic

Diseases of the children referred: “tuberculosis; rickets; gonorrhea; feeding problems; chorea; heart disease; whooping cough.”

1912 EDUCATION: Boston (Simmons) School of Social Work

Cannon and Cabot advise on curriculum and teach medical social work. Students do field education at MGH during their second year.

1913 FIRST SOCIAL WORKER: Research

Social worker joins Dr. Edsal studying “lead poisoning cases.” Resultant criteria used in new Occupational Disease Clinic.

1913 FIRST SOCIAL WORKER: Occupational Disease

1. Screens all outpatient charts daily watching for occupations such as painter, rubber worker, tinsmith, or stone cutter.

2. Educates these patients re: dangerous processes and what precautions to take.

3. Submits information to physicians.

4. Studies what needs to be reinforced by legislation.

5. Follows-up on all 147 cases of lead poisoning seen.

1913 - 1918 FIRST SOCIAL WORKERS: Specialty Clinics

Social workers are assigned to Syphilis Clinic, Genito-Urinary Clinic, Diabetic Clinic, Orthopedic Clinic, Infantile Paralysis Clinic and Neurology Clinic.

1914 CHIEF OF SERVICE: Ida Cannon appointed Chief of Social Service. Assumes responsibility for social worker on inpatient services. Hospital pays for in-patient social worker; Supervisory Committee pays for out-patient social workers. Ruth Emerson, first trained social worker, appointed Head Worker in the wards.

1912 PRACTICE: What Works?

As social work is practiced, the staff and leadership are simultaneously developing methods and theory.

1927

Group work first used as treat- ment modal- ity

1929

The Great Depression

1934

Federal Crippled Children’s Program organized

1917 DISASTER: Nova Scotia

Explosion of ammunition ships in Halifax Harbor causes 1,600 deaths and numerous injuries. Ruth Emerson and Edith Baker go to Halifax to:

1. Aid victims with clothing and shelter 2. Arrange after care and follow-up appointments for injured

3. Establish special care for injured children 4. Conduct a census of those handicapped 5. Provide intensive case-work for those with social problems

Miss Emerson stays on helping to establish medical social service permanently in Halifax.

1918 PRACTICE: Feeding Clinic for Infants

“Purposes: to make sick babies well; to teach mothers how to keep them well; to reduce the death rate among babies; to teach mothers motherhood.

Methods: improved milk supply; supervision of well babies; encouragement of breast feeding; milk fund for needy families; instructions in proper feeding; home visits by nurse; cooperation with public health authorities and social agencies on matters affecting infant welfare.”

1919 ORGANIZATION: Officially Accepted

By vote of the Trustees, Social Service becomes both administratively and financially an integral department of MGH. Supervisory Committee becomes the Advisory Committee.

Ida Cannon: “... for 14 years we were free to try experiments and make mistakes.” We are now “officially accepted.”

1918 EDUCATION: Summer Institute

Students come for practical work from Smith College, Boston School of Social Work and the Red Cross Institute.

1935

Maternal and Child Health Services established

1938

Minimum Wage established, 25 cents per hour

1938

March of Dimes established to fight polio

1939

World War II begins

1940

Penicillin available to non-military patients

1941

MGH establishes its 1st Emergency Plan

1942

Cocoanut Grove nightclub fire

Ida Cannon’s Motto Ida keeps this drawing on her desk. It exemplifies her approach to developing a new service in a conservative, tradition-bound institution.

1915 10th ANNIVERSARY: Major challenge: meeting the individual needs of so many patients. “Should we be focusing on mass work (populations) or individual work?” Over 200 social workers from across the country gather to talk about progress, mutual difficulties and look into the future. Staff includes:

13 social workers

4 stenographers

19 student social workers

8 student nurses

64 volunteers

Budget: $11,626.07

1929 FIRST SOCIAL WORKER: Tumor Clinic

Social workers supported by a 2-year DPH grant. At surgeons’

1930 25th ANNIVERSARY: Two hundred fifty gather and Dr. Cabot speaks on “The Future of Hospital Social Work.” Donors give over $20,000 in honor of Dr. Cabot establishing an educational fund for social workers.

1931 EDUCATION: Director Named

Salaried from the Cabot Fund, Harriett Bartlett (below center) joins as educator. She studies the functions of medical social work and the role of social workers in the teaching of medical students.

1936 PRACTICE: Home Care for Children with Heart Disease

Social worker institutes “In-Bed Club” and “In-Bed Magazine” for children with rheumatic fever. A “Mothers Club” and summer craft and educational programs are initiated.1939

OFFICE SPACE: Enlarged Corner

1930 FIRST SOCIAL WORKER: Baker Building

Josephine Barbour assigned to “patients of moderate means.” Cannon insists patients need social services without regard for income or social status. Quickly physicians began requesting assistance for their private patients in the Phillips House.

9--bed room – $24 per week

4-bed room – $4 a day

2-bed room – $5 a day

Single room – $6 and $6.50 a day

Operating room fee – $15

Delivery room fee – $15

Maximum professional fee – $150

1946

J. Barbour receives U.S. government’s Medal of Freedom

1949

Boston Housing Authority administers funds for urban renewal

1950

Ida Cannon receives honorary doctorate from Boston University

1954

Brown v. Board of Education mandates school desegregation

1955

All social work specialty groups join to become NASW

1955

Peak of polio epidemic

1956

Salk polio vaccine made available to the public

1960

Boston’s West End begins redevelopment

1961

Harriett Bartlett writes Social Work Practice in the Health Field

1942 ORGANIZATION: Staff Shortages

The pressing demand for medical social workers in Army and civilian hospitals makes it difficult to secure well-prepared workers to fill vacancies. Staff is in constant contact with the Red Cross providing family health reports for servicemen.

1945 ANNUAL REPORT:

The six most frequent problems presented by patients:

Chronic Disease: 1072

Convalescent Care: 587

Family Relationships: 544

Financial problems: 476

Patients Attitudes: 468

Physical Handicap: 368

1947 FIRST SOCIAL WORKER: Staff Clinic for Employees

1950 FIRST SOCIAL WORKER: Emergency Ward

1950 FIRST SOCIAL WORKER: Cardiac Service

1951 FIRST SOCIAL WORKER: Alcohol Clinic

1947 RESEARCH: Expands via Grants

Grants enable staff to collaborate with MD’s studying adults with hypertension and children with heart disease, asthma, arthritis, mental health problems and undergoing tonsillectomies. Ruth Abrams is hired to collaborate with physicians conducting research with cancer patients.

1942 DISASTER: Cocoanut Grove Fire

Social workers assist relatives seeking to identify victims, serve as liaison to the Red Cross and counsel victims and families. Ida Cannon and Dorothy Kellogg publish their work in the “Annals of Surgery” and “The Family” in 1943.

1945 NEW CHIEF: Josephine Barbour, on staff since 1926, and upon return from her duties in North Africa, becomes the second Director.

1964

U.S. escalates Vietnam War

1964

War on Poverty increases services to the poor

1964

Civil Rights Act

1964

Food Stamp Act

1965

Medicare and Medicaid enacted

1942 WAR: Granted a leave of absence, J. Barbour, Cannon’s assistant, joins the MGH Hospital Unit. Later she is promoted to Field Director for Red Cross supervising all medical social workers in Mediterranean.

1965

Older Americans Act

1967

St. Christopher’s Hospice opens in London, England

1957 PRACTICE: Social Work in Psychiatry

Social workers specialize: Adult (ward and clinics), Child, Community Mental Health, Alcoholism or the West End Research Project.

1958 PRACTICE: Fees

After careful study, fees are instituted for patients seen by social workers in Psychiatry. Average cost per interview: $4.72. Average hourly pay for social workers: $2.50. Fee is prorated based on length of interview.

1963 PRACTICE: Twenty-four hour coverage in the Acute

1967 PRACTICE: Patient Activity Center (PAC)

A unique social and day health program is developed for clinic patients with chronic illnesses. Many serve as MGH volunteers; some become employed.

1955 EPIDEMIC: Polio

“The unforgettable, haunting picture of over 400 polio patients.” Social Service sets up a special polio office to extend support to victims and their families.

1949 EDUCATION: Foreign Visitors

Visitors come from India, China, Greece, Japan, Sweden, Argentina, South Africa, Virgin Islands and England to train in Social Services.

1972

SSI consolidates Aid to Blind, Aid to Disabled and Old Age Assistance

1973

Roe v. Wade legalizes abortion

1964 NEW DIRECTOR Eleanor Clark, MSW, Supervisor in Adult Psychiatry, is promoted, becoming the third Director.

1955 50th ANNIVERSARY Over six hundred and thirty attend. Special guests include Miss Cherry Morris (England) and Mlle. Marie Terese Viellot (France). Staff includes: 35 professional social workers, 4 case aides and 12 secretaries.

1972

Chelsea HealthCare Center opens

1968

Charlestown HealthCare Center opens

1968 FIRST SOCIAL WORKER: Renal Dialysis and Transplant

1968 PRACTICE: Transfer Office

A team of nurse, social worker and administrative assistant develop services to assure that all patients receive appropriate care after discharge whether to home or to community facilities. Agreements are established between MGH Social Service and nursing homes. Consultations to ambulance companies improve patient transport. Contracts are made with the Boston VNA for an in-house liaison. Day care is established at the Don Orione Nursing Home. MGH house staff with social workers make visits to

1968 PRACTICE: Continuing Care Planning Unit

For the first time nurses are hired in a Social Service Department. They are responsible for tailoring patients’ individual discharge plans and for evaluating nursing homes.

1968 FIRST SOCIAL WORKER: Bunker Hill HealthCare Center

Social worker joins new Family Health Service. Major focus of early work is care of the chronically mentally ill. Social Service Unit expands staff and community-based programs.

1970 ANNUAL REPORT “Poverty, isolation and depression are predominant problems in our caseload. Alcoholism, drug usage, requests for assistance with unwanted pregnancies and problems of family breakdown leading to neglect and abuse of children are increasingly reasons for referral. It is reported that traditional social agencies fail to encounter or assist many of this population. Perhaps it is our medical setting which encourages the most needful to our door.”

1973 FIRST SOCIAL WORKER: Chelsea Health Center

Social worker joins the newly opened Chelsea Health Center. Is soon named Unit Chief of Mental Health and Social Services, which rapidly expands to serve the entire Chelsea community – including immigrants from many countries. Many innovative outreach programs characterize practice.

1978 PRACTICE: Child Protection

The Mental Health and Social Service Unit of the Chelsea Health Center receives state grant to provide comprehensive services to all at-risk children in the city of Chelsea. First time that child protection services are under the auspices of a health center.

1978 PRACTICE: Family Care Program

The first hospital-based, state funded, foster home service offers an alternative to institutional living for adults who need care and supervision. Nurse/social worker teams match patients to families and provide ongoing oversight to both patient and family.

1979

NASW adopts Code of Ethics

1973

Medicare extended to the disabled

1974

Child Abuse Prevention and Treatment Act funds programs

1977

Massachusetts requires licensure of social workers

MGH INSTITUTE OF HEALTH PROFESSIONS

1980 PRACTICE: Screening of all Admissions

Social Service initiates the screening of all admissions using criteria based on diagnosis, age, demographic characteristics and living arrangements. Allows early identification of patients at risk for discharge planning problems.

1980 EDUCATION: Institute of Health Professions Opens

Barbara Berkman, DSW directs new certificate program in social work. Begins as pre-MSW program and transitions to a post-MSW program.

1987 FIRST SOCIAL WORKER: Revere HealthCare Center

Social worker is hired. Early work includes special services to immigrant Cambodians enabling them to fully utilize and benefit from medical services. Program grows and new staff is added.

1987 RESEARCH: New Position

Research and Quality Assurance Program initiated. Grants from American Cancer Society fund post-graduate Social Work Oncology Traineeships.

1990 FIRST SOCIAL WORKER: Fox Hill Village

Health team (social worker, nurse, physician) opens Wellness Center for residents of MGH affiliated retirement village in Westwood.

1993 FIRST SOCIAL WORKER: AIDS and HIV

1994 PRACTICE: Obstetrics

After 50 years, Obstetrics returns to the MGH. Simultaneously social workers are hired to develop broad in- and outpatient services. Social worker previously added in the Fertility Center (IVF).

1987 PRACTICE: Coordinated Care Program

Following a successful demonstration funded by a Robert Wood Johnson Grant, a nurse/social worker team evaluates and coordinates the care of frail elders in their own homes.

1980 75th Anniversary Staff social worker receives prestigious award from Harvard University’s Ella Lyman Cabot Trust.

1981

U.S. reports its 1st AIDS case

1981

Revere HealthCare Center opens

1984

Friends of MGH Cancer Center, strong supporter of Social Work

1987

McKinney Homeless Assistance Act addresses needs of the homeless

1990

Americans with Disabilities Act is passed

1990

MGH Employee Assistance Program is organized

1985 NEW DIRECTOR Evelyn Bonander, MSW, comes from Barnes Hospital and Washington University Medical Center in St. Louis, Missouri to be the fourth Director.

1994 PRACTICE: Community Resource Center

The center provides clinicians with computerized access to information about community services and public benefits. Updates staff on legislative activities enabling timely and effective advocacy. Resource specialists assist cancer patients with transportation and accommodations.

1995 PRACTICE: Major Role Changes

Social work joins in restructuring of patient care. Continuing Care nurses transfer to Case Management which assumes responsibility for discharge planning. Social workers focus on clinical work collaborating with all on health care team.

1996 PRACTICE: Cancer Center

MGH Cancer Center reorganizes into Disease Centers. Social workers are requested as specialists for Breast, Brain Tumor; Bone Marrow; GI, GU, Gyn, Head and Neck, Hematology, Melanoma, Proton Beam, Sarcoma, Thoracic, Pediatrics and Radiation. Social work staff and program expand.

1996 FIRST SOCIAL WORKER: Palliative Care Service

1997 ORGANIZATION: Collaborative Leadership Teams

The Social Service Department reorganizes as Patient Care Services is restructured. Structure becomes: Leadership Team, Specialty Programs, nine Self-Managed Staff Teams and Steering Committee.

1997 PRACTICE: HOPES Program

This unique, multidisciplinary program offers educational and support workshops for cancer patients and their families. Also sponsors wellness programs like yoga, music, expressive arts, massage.

1996 PRACTICE: Cancer Resource Room (CRR)

The CRR offers a unique blend of clinical support and educational resources for cancer patients and their families. Hosts support, educational and wellness groups.

1997 PRACTICE: HAVEN Program

Social worker with staff of advocates begins program of services to victims of domestic violence. Program expands in collaboration with the EAP to employees and grows to include deployed advocates at Chelsea and Revere Health Centers.

1995 FIRST SOCIAL WORKER: MGH Senior Health

Social worker joins new Geriatric Practice. With additional staff, develops MGH SeniorHealthWise to service the local community of seniors providing health and wellness programs, screenings, education and linkage to social and health services.

1995

Partners HealthCare forms: MGH joins with Brigham & Women’s Hospital

1995

Case Management assumes responsibility for discharge planning

1995

Community Benefits Program partners with social work in community outreach

1996

Welfare Reform enacted: creates Temporary Assistance for Needy Families, ending categorical programs

2000

North End Health Center joins MGH Partners HealthCare

2001

September 11, 2001

2003 AFFORDABLE LODGING: Major Changes

Beacon House opens in 1984, beautifully furnished by the Ladies Visiting Committee. MGH at the Inn opens in 1996. In 2003, Beacon House is refurbished and MGH at the Inn moves to Somerville.

2000 PRACTICE: Child Protection Consultation Team

Team of social worker and physicians provide 24-hour consultation to all clinicians caring for at-risk children.

2000 PRACTICE: Visiting Moms

In collaboration with Community Benefits, experienced, paraprofessional, bicultural mothers are trained to visit and support new mothers (primarily immigrants and refugees) through the Chelsea Health Center and supervised by social worker.

2001 PRACTICE: Backpacks

Therapeutic backpacks help parents talk with their children about cancer, trauma, sudden illness or grief. Each pack has developmentally appropriate educational, comfort and expressive items.

2003 ORGANIZATION: Clinical Recognition Program

Patient Care Services creates a program to formally recognize clinical staff for their expertise. Social workers participate in every aspect from design to implementation. Staff apply for recognition as Clinicians, Advanced Clinicians or Clinical Scholars.

2003 DISASTER: Rhode Island Fire

Social workers organize a center providing services to families seeking identity of, and information on, victims of night club explosion and fire. Families and the victims admitted receive ongoing

2005 NEW DIRECTOR: Ann Daniels MSW, PhD, is promoted from Clinical Director, becoming fifth Director.

2005 DISASTER: Tsunami in Indonesia

Three social workers, along with other MGH clinicians, provide disaster relief aboard the USNS Mercy.

1998 PRACTICE: PACT Program

In response to the Chelsea community’s concern about violence, the Police Action Counseling Team is formed to address the needs of children witnessing violence. Chelsea HealthCenter social workers join Chelsea Police reaching out to children.

2003

War in Iraq begins

2003

Rhode Island nightclub fire

2004

Tsunami hits Asia

2005

MGH Men Against Abuse: First hospital-based men’s group committed to heightening awareness of violence against women

2005

Hurricanes Katrina and Rita devastate the Gulf States

2005

MGH Cancer Center dedicates healing garden in the hospital’s new Yawkey Building