HEALTH RESOURCES AND SERVICES ADMINISTRATION

MATERNAL AND CHILD HEALTH BUREAU

Social Work in MCHB: Some Historical Social Work in MCHB: Some Historical HighlightsHighlights

Presentation to LEND Social WorkersMCHB, DRTE

byIsadora Hare, M.S.W., L.C.S.W.

Perinatal Health SpecialistMCHB, DHSPS

Crystal Gateway MarriottCrystal City, VA4 March, 2006

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Isadora Hare, M.S.W., L.C.S.W.5600 Fishers Lane

Room 18-12Rockville, MD 20857

E-mail: ihare@hrsa,hhs.govPhone#: 301.443.9720Fax#: 301.594.0186

Contact Information:

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Trends and Events Prior to Social Security Act of 1935

> Dismal conditions for mothers, infants and children; high mortality rates

> Post-Civil War, a few states established State health departments (14 by 1877)

> 1907 – New York City established Division of Child Hygiene under Dr. S. Josephine Baker

> 1911 – Nine states had mandatory school health inspection laws

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The Children’s Bureau, 1912 - 1969

> 1909 First White House Conference on the Care of Dependent Children

> April 9th, 1912 : Children’s Bureau (CB) established in Department of Labor and Commerce

> Broad mission “……. All matters pertaining to the welfare of children ……. infant mortality, birth rates, orphanages juvenile courts, employment, desertion, dangerous occupants, accidents and diseases ……..

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Julia Lathrop 1858 - 1932

> 12 years as Director of Children’s Bureau> Vassar College, 1880; Hull House> Well-known advocate for children and mentally ill

people> Investigated infant mortality; promoted registration

of births> Produced two pioneering publications:

Prenatal Care 1913Infant Care 1914

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Social Work Leaders in MCHPolicy and Services

First six Chiefs of the Children’s Bureau were social workers:

Julia Lathrop 1912 - 1921Grace Abbott 1921 - 1934Katherine Lenroot 1934 - 1951 Martha May Eliot 1951 - 1957Katherine Oettinger 1957 - 1968Fred Deliquadri brief tenure

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Leaders in social policy and programs:

Frances Perkins - Secretary of Labor, 1933 - 1945

Edith Abbott - Dean of S5 SA, University of Chicago, 1924 – 1942

Milton Wittman, NIMH 1947 - 1979, NIMH

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Leaders in MCH Social work programs:

Edith Baker, first Chief of Medical Social Work, Children’s Bureau, post 1935 - 1955

Virginia Insley 1955 - 1980

Juanita Evans 1980 - 2000

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History of Public Health Service and

Commissioned Corps.

1798- President John Adams establishes Marine Hospital Fund for relief of seamen

1870- Hospitals reorganized after Civil War Surgeon General appointed Military model adopted: ranks similar to U.S. Navy

1889- Commissioned Corps formally established: social workers enter Corps in 1950

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History of Public Health Service and

Commissioned Corps.

1891- Assigned responsibility for medical inspection of immigrants

1912- Name of Service changed to Public Health Service: provides wide range of services

1929- Establishes formal unit for mental health issues

1935- Social Security Act

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History of Public Health Service and

Commissioned Corps.

1944- Public Health Service Act codifies authorities of the PHS

1946- National Mental Health Act: Social Work Training

1953- President Eisenhower- DHEW

1970- National Health Service Corps- few slots for social workers

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MCH Policy Developments before 1935

1918- Children’s Year

1920- 19th Amendment: Votes for Women

1921- Sheppard-Towner Act: Maternity and Infancy Act, PL 67-97. First Federal formula grant program in health

1927- 47 States + Hawaii provided matching funds for MCH activities

1929- S-T Act expires

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MCH Policy Developments before 1935

1930- President Hoover convenes White House Conference on Child Health and Protection

1930- Great Depression begins

1933- Frances Perkins: Secretary of Labor

1934- President Roosevelt creates Committee on Economic Security: chaired by Perkins

1934- Consultants included Grace and Edith Abbott; Katherine Lenroot; Dr. Martha May Eliot

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Frances Perkins: 1882-1965

• Secretary of Labor appointed by President Roosevelt, 1933-1945; First woman member of a U.S. cabinet

• Hull House- Masters from Columbia 1910

• Became authority on industrial conditions and hazards

• Advocacy for minimum wages, maximum hours, child labor legislation, unemployment compensation, social security

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The Social Security Act, P.L. 74-271, 1935

• Title V provides for Federal-State partnershipsto promote MCHto promote care for “crippled children”(1985- COBRA- “children with special health care needs”)to strengthen public child welfare services

• By June 1937, all States and Territories have MCH divisions

• Before 1935, only one State (MA) and one County (LA) had public health social workers

• Social Security Act brought social workers into public health programs nationally

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Edith Baker

• Lobbied for social work in implementation of Social Security Act through American Association of Medical Social Workers

• Worked with Dr. Martha May Eliot, social worker and pediatrician---Chief of C.B. (1951-1957)

• Became first Chief of Medical Social Work for MCH and CCS, 1936-1955

• Federal policy required States to have social workers in CCS, and later in various MCH programs

• Strong recognition of training needs

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Virginia Insley

• 2nd Chief of Social Work in C.B.- 1955-1980. Formerly Regional Medical Social Consultant, C.B.’s San Francisco Regional Office

• 1953- Pres. Eisenhower establishes DHEW; C.B. placed there within Social Security Administration

• 1963-1969- C.B. transferred to various administrative units in reorganizations of DHEW

• 1969- C.B. dismantled: MCH and CCS programs (Title V) transferred to US Public Health Service; moves to Rockville

• 1977- Disciplinary Sections abolished

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Virginia Insley

• 1977- Disciplinary Sections abolished: Insley’s title remains “Chief Social Worker”

• Succeeded by Juanita Evans, 1980-2000

• 1990- Maternal and Child Health Bureau established within HRSA

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Juanita Evans“Chief Social Work Officer”

1980-2000

• Though Disciplinary Sections abolished in 1977, Insley retains title “Chief Social Worker”

• Juanita Evans succeeds Insley in 1980• Continues social work activities through grants:

e.g. 1985, Working Conference of the Public Health Social Work Advisory Committee“Public Health Social Work in Maternal and Child Health: A Forward Plan”

• Sponsored by Columbia University School of Social Work, Alex Gitterman

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Services for “Crippled” Children

• 1897- Minnesota- first state to serve crippled children-followed by MA and NY

• 1850-1900- Volunteer organizations working for improved services; educating blind and deaf

• Until 1935, very few State dollars spent on services for handicapped children

• Citizen groups e.g. National Society for Crippled Children and Adults, grew active in advocacy efforts

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“Mental Retardation” (MR) in Children

• Parents kept children hidden or sent them to “asylums”

• By 1898, 24 public institutions for “feebleminded” children existed in 19 states, by 1918, all but four states provided institutions

• 1915- Children’s Bureau conducted study of “Mental Defectives in the District of Columbia”

• 1923- Children’s Bureau study of work potential of children who had been in special classes for “mental defectives”

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“Mental Retardation” cont’d: The 1950’s

• A new approach developed through parent activism

1950- Foundation of National Association for Retarded Children (later Citizens) directed by Gunnar Dybwad, a social worker

1954- Dr. Martha May Eliot designated “mentally retarded”as a group needing special emphasis

1955- C.B. makes 4 grants for special demonstrations of clinical services for the M.R.- social workers included in multidisciplinary teams

1958- Congressional earmarks: $2 million of Title V to develop MR clinical services; new diagnostic and education (D and E) clinics established

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“Mental Retardation” cont’d: The 1960’s and 1970’s

• Increasing influence of NARC and leadership of Pres. John F. Kennedy

• Presidential Panel appointed

• President deliver message relative to Mental Illness and Mental Retardation

• Congress enacts recommendations from President’s Panel; Legislation establishes UAF’s (later UAP’s) and LEND program

• 1970- Developmental Disabilities Act: new terminology

• 1975- Education for All Handicapped Children Act,

PL 94-142