EXCELLENCE EVERY DAY PORTAL
1905 - 1945
Dr. Richard Cabot, a senior physician at Mass General, hired the first social worker in 1905 to provide social work services in the outpatient clinics. In 1906, Dr. Cabot met Ida Maude Cannon and hired her to jointly organize the nation's first hospital-based social work program. Of Cabot, Ida commented, "He was presenting the idea of social service within the hospital where sick patients, although separated from their home and families, nevertheless cannot separate themselves from their personal problems." At the time, Ida Cannon was enrolled in the newly established Boston School for Social Work (now Simmons College). Upon her graduation in 1907, Cannon joined Cabot's staff as a permanent member.
In 1914 Ms. Cannon was named Chief of the Mass General Social Service Department, the first organized social work department in a hospital. This was a significant appointment as only three Chiefs functioned in the hospital at that time, Chief of Medicine, Chief of Surgery, and, then, Chief of Social Work.
The social work program was further developed under her tenure and became a department at Mass General in 1919. At its inception and for the first ten years, social workers provided care in the out-patient clinics. The focus was not only on the patients' medical care but also broadened to include community and environmental awareness as it impacts patient care. Mass General social work services began by helping patients afflicted with neurological ailments, venereal disease, and tuberculosis.
From its inception, the department of social work was interdisciplinary, including physicians, nurses, teachers, and volunteers, and Ms. Cannon's goals were to "make medical care effective" and, in particular, to "cure consumption". Tuberculosis accounted for one-third of all deaths of people between the ages of fifteen and fifty-four, inflicting severe emotional and economic strain on patients and families. Once it was revealed to be a communicable disease, a committee of social workers investigated the social correlates of tuberculosis, such as incidence, symptoms, severity, and possible means of prevention, and then made recommendations which became integral parts of medical treatment. These social workers were the first professionals to perform a comprehensive analysis of tuberculosis in the United States.
The Mass General social workers also addressed the needs of unmarried pregnant adolescents and children with orthopedic problems. Ms. Cannon created specialized programming in the department, and insisted that social workers have sufficient medical training and that nurses who wanted to be part of the department get training in social work and casework. The department created innovative and eclectic programs, such as clay modeling classes for patients with "nervous disorders" (those we now identify as psychiatric disorders), and "hygiene education" primarily for adolescent girls and young mothers. They developed affiliations with convalescent homes, planned country outings for those with "nervous disorders," and researched the effects of lead poisoning. The department also established a low-cost lunch counter for patients and staff. Social work training emphasized understanding the individual in the larger societal context. Ms. Cannon studied the effects of occupation on disease and encouraged the social workers to examine how environment affected illness. Ms. Cannon was a strong advocate within Mass General for treating patients from the inner city, rather than depleting all the hospital's resources by treating affluent suburbanites who likely had access to other resources.
Ms. Cannon and Dr. Cabot implemented systems to measure social work interventions, to document these interventions in medical charts, to collaborate with medical professionals, furthering the profession of medical social work. Their work promoted the expansion of the social work role in the hospital and the inclusion of the social perspective as a regular part of the medical treatment plan, for instance they began what we know today as "rounds". In a 1930 address Ms. Cannon stated, "The medical social service movement recognized that there should be within the hospital, someone definitely assigned to represent the patient's point of view... And to work out with the physician, an adaptation of the medical treatment in the light of the patient's social condition". To realize this goal, interdisciplinary rounds with social workers were begun, and continue to exists today.
In her effort to broaden the scope of the profession, Ms. Cannon hired the department's first educational director, Harriet Bartlett. Ms. Bartlett wrote the first textbook, Social Work Practice in the Health Field, and was also a well-known social researcher. She created educational programs, which helped social workers clarify the function and quality of their work, and to broaden their professional growth. She also established supervisory processes, social work student fieldwork, and clinical case conferences. Her work and expertise became recognized beyond the department and the hospital and was implemented in the broader field of medical social work.
Dr. Cabot and Ms. Cannon successfully collaborated at Mass General for 40 years. They created a department that combined sound clinical practice with political action and community service. Dr. Cabot and Ms. Cannon traveled extensively throughout the United States and abroad, lecturing on their seminal work. They were both instrumental in the establishment of several national health-care and social service organizations. Ms. Cannon brought her ideas to hospitals throughout the United States and helped develop a standardized program for training medical social workers.
Ms. Cannon also assisted in founding the American Association of Hospital Social Workers in 1918 and was the recipient of the Massachusetts Public Health Association's Award for Distinguished Service. Since 1971, the Ida M. Cannon Award has been presented annually to an administrator of a social work department in a health care setting who has demonstrated outstanding leadership. This is the highest award given by the Society for Social Work Leadership of the American Hospital Association. Many of Ms. Cannon's early principles of sound social work practice, especially her strong patient advocacy, continue to represent core values for practitioners of her profession in the dawn of the 21st century!
1945 - 1985
Ms. Barbor was also committed to working with the Supervisory Committee, comprised of Cabot, other key physicians, ladies in the community (Ladies Visiting Committee), and hospital administrators, to secure hospital finances and oversee department work and department finances. Today's "endowments" (funds to assist patients and their families) grew out of these early fiscal efforts. As the multidisciplinary approach to health care developed, physicians and nurses increasingly relied on social workers to address the interrelationship of physical, emotional, and social factors in the diagnosis and treatment of diseases. Social work practice expanded to patients who were stricken with polio, cancer, heart disease, venereal disease, and as aforementioned, tuberculosis. This was an exciting era for social workers, because it was the first time they were fully integrated into patients' medical treatment. Their caseloads increased dramatically, and the department was challenged to provide high quality treatment to a growing patient population with ever increasing social needs. They adapted their practice, learned new techniques, and continued developing trusting relationships with patients, while providing compassionate, competent care.
Eleanor Clark, who had also been an Mass General social worker, succeeded Ms. Barbor in 1964. Ms. Clark's expertise was in outpatient psychiatric social work, and she led the department during an era of sweeping social reform. During Ms. Clark's tenure, Medicare and Medicaid funding for the first time provided universal access to health care for the nation's elderly and indigent populations. Noted for innovation, Clark developed the Transfer Office and the Adult Foster Family Care Program. The Transfer Office assured continuity of care for patients from the hospital to the community, through a team of social workers and continuing care nurses. The Adult Foster Family Care Program provided foster care as an alternative to nursing homes for elderly patients, and was later expanded to include persons with disabilities and HIV. This program is an active part of the Social Services Department today. Together with an Mass General trustee, (Mrs. Jane Mortimer Clafflin) Ms. Clark was also instrumental in the creation of the Chelsea Health Center, which continues to be an integral part of that community.
Ms. Bonander was instrumental in the founding of a new and highly specialized program for survivors of domestic violence, called HAVEN, Hospitals Helping Abuse and Violence End Now. This program has become an integral patient care program and has received much recognition in the community.
The Mass General Social Service Department can also be credited for continuing to uphold its original mission despite fiscal pressures and budgetary constraints: strong clinical care, programs that address current psychosocial issues, and ongoing research and education.
Ann Daniels was named the fifth director of the department in June 2005, the first director to hold a PhD. Today, Mass General social workers continue to be in the forefront of their profession, initiating new programs and services to meet the changing needs of patients and families. Social workers were recently made a permanent part of Mass General's disaster response teams and delployed in Indonesia and the United States Gulf Coast. Now with a staff of over one hundred, the department looks forward to new leadership and continued growth and innovation.
Marie Elena Gioiella, MA, MSW, LICSW has worked at the hospital since 1994 as a clinical social worker and has served as clinical director of the MGH Social Work Oncology Program since 2006. Gioiella earned a bachelor's degree from the College of the Holy Cross and two master's degrees in Social Work and Pastoral Ministry from Boston College.
During her career at the MGH, she has been an active member of the Clinical Recognition Program Review Board, the Disabilities Awareness Council and the Cancer Center Community Outreach Program. She has been recognized with a number of honors, including the Domestic Violence Unsung Hero Award, the Arthur and Susan Durante Award for Exemplary Care and Service with Cancer Patients, and the Stephanie Macaluso Expertise in Clinical Practice Award. She also has been named a Clinical Scholar by the MGH Clinical Recognition Review Board. Gioiella has published extensively and presented her work nationally.
Marie Elena Gioiella
Massachusetts General Hospital 55 Fruit Street, Boston MA 02114 / (617) 726-2000 / TDD: 617-724-8800