This paper traces the development of social work in the United States from its origins in the late nineteenth century through the policy reforms of the 1990s. Beginning with the first professional social workers hired at Massachusetts General Hospital in 1905, the paper examines how waves of immigration, economic crises, world wars, and shifting political philosophies shaped the profession. It surveys landmark legislation — including the Social Security Act of 1935, the Economic Opportunity Act of 1964, and Medicare and Medicaid — and highlights the founding of major professional bodies such as NASW and CSWE. The paper concludes by affirming social work's enduring mission to advocate for vulnerable populations.
Social work in health care began in the late nineteenth and early twentieth centuries in the United States. The first social work classes were offered in the summer of 1898 and were designed to facilitate the development of private and charitable organizations serving people in need (Social Work History, 2011). Changes in demographics, attitudes about how the sick should be treated, and growing recognition of social and psychological factors all facilitated the emergence of this field.
The mass migrations — chiefly from Europe — in the nineteenth century landed many immigrants in New York and other eastern cities. This influx of people led to mass crowding, increased social problems, and widespread ill health. In 1905, Massachusetts General Hospital hired the first professional social worker. Dr. Richard Clarke Cabot believed there was a connection between tuberculosis and social conditions. Cabot, who was in charge of the outpatient ward, along with his newly created social work staff, redefined the way health and well-being were managed. For the first time, economic, social, family, and psychological conditions contributing to many health issues were formally recognized. Soon, social workers were attending to social health issues in conjunction with medical doctors who addressed physiological ones. By 1911, there were 44 social work departments in 14 different cities, and by 1913 that number had grown to over 200 (Gehlert & Browne, 2006).
Tannenbaum and Reisch (2001) report that during World War I, the expansion of government agencies led to increased professionalism in public-sector departments devoted to social welfare. Through the Red Cross and the Army, the war also provided opportunities for social workers to apply casework skills to the treatment of soldiers suffering from "shell shock." Social workers were now sought as specialists in the social adjustment of non-impoverished populations. By 1927, over 100 child guidance clinics had appeared, in which teams of psychiatrists, psychologists, and social workers provided services primarily to middle-class clients.
In 1930, the U.S. social welfare system was an uncoordinated mixture of local and state public relief agencies, supplemented by the modest resources of voluntary charitable organizations. The Great Depression profoundly influenced social work practice and redefined the role of government as an instrument of social welfare. The public began to view poverty as the result of economic circumstances rather than personal failure, and the idea that social welfare assistance was a government responsibility — rather than a private charitable function — gained wider acceptance.
This change in perception eventually evolved into a complex national social welfare system. The Social Security Act of 1935 expanded and improved standards of social welfare throughout the country, helped establish an unprecedented regular role for the federal government as a source of aid, and introduced the concept of entitlement into the American political vocabulary. The scope of social welfare expanded beyond financial relief for the poor to include housing, rural problems, recreation and cultural activities, child welfare programs, and diverse forms of social insurance for Americans of all classes.
"NASW and CSWE formalize social work as a profession"
"Johnson's antipoverty programs expand social worker roles"
"Nixon-era shifts, Reagan cuts, and welfare reform challenges"
"Core mission persists despite decades of policy change"
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