Reflections on an Elusive Vision: Social Work in Health

Abstract

HIS paper is a personal evaluation of trends in the conceptualization and practice of social work in the health m t 2 2 field. It is written from the perspective of some forty I 5 years' experience, nearly half of it as practitioner, adnministrator and researcher, and the rest as an academic lee A in public health and social work. It is appropriate to begin with some of the history of social work in the health field, an unhappy history, it seems to me, of missed opportunities and misdirections. When I came into graduate education in social work in the early 1940s, we were given what seemed an adequate introduction to the health field. We had courses in medical information, in the psychosocial aspects of chronic illness and disability, in social policies and social provisions for health services. It seemed certain and natural to me, and to other novitiates, that all the tools in social work's kitbag-case work, group work, community work-would effectively be used to help people overcome the disabling social and psychological accompaniments of illness. We had learned that social work's special contribution, its claims as a separate profession, rested on three pillars: first, an eclectically derived understanding of individual behavior as always involving the interplay of the idiosyncratic elements of genetic biological endowment, personal history, and the immediate social situation; second, that clients' inability to use social institutions in satisfying and capacity-fulfilling ways constituted the chief grounds for social work interventions; and third, that these varied interventions in case, group and community work, when selectively and skillfully made, would make a significant difference in the lives of individuals and groups.