医务社会工作课程发展

1912 年， Ida Cannon 开办了第一个医务社工课 程；

1929 年， 十家大学开办了医院社工的课程， 主 要为 Master Degree of Social Work。
Washington U., U. of Chicago, NY School of SW, Tulane U., U. of Indianna, U. of Missouri, Simmons College, Western Reserve U., Penn School of Social and Health, National Catholic School of SW 名校
知识领域1：
1.
精神，心理，行为健康概念
The interplay between the physiological elements of acute, chronic, and life-limiting illness and biopsychosocial-spiritual functioning Concepts and theories associated with life span development, neurobiology, and behavioral change

从医院到公共卫生 Hospital and Health Social Work

1960年， 二战和Social Security Act 共卫生与健康社会工作的发展；
加速了公

1971年，已有11576 健康社工 ， 来自 6935 家参 与医院;
• 医院转战社区？金钱推动? • Hospital social workers are no longer hospital based.
MGH-IHP
重新设计医务 社工课程
1986 AHA：健康领域社会工作文献重温
In 1986, the Society for Hospital Social Work Directors reconfirmed its commitment to the education of social workers in health by requesting the Institute’s faculty to update the earlier work on knowledge-base needs for social work in health. The results of those efforts have been published by the American Hospital Association in a book, Social Work in Health Care: A Review of the Literature [5]. Eighteen areas of knowledge needed for effective practice in health care are conceptualized.
7. 8.
知识领域2：
1. 2.
健康服务体系
The health care continuum
The unique needs of marginalized, oppressed, and diverse populations
3. 4.
The social determinants of health and health disparities
刘斌志（2008）

生活压力理论
社会医疗理论 危机调适理论 团队医疗理论
2014 : NASW - Standards for the Health care Social Work

4大范围，42个知识领域
Knowledge Base
1. Physical, mental and behavioural health 精神，心理，行为健康概念 2. Health care systems 健康服务体系 3. Roles and responsibities 社工角色和责任 4. Research and evaluations 研究与评估
医务社会工作课程发展
黄匡忠
医务社会工作的起源 (Gehlert, S. & Browne, T., 2011)：
谁买单？

Mary Stewart 的岗位是医院出一半， London Charity Organization Society出一半的；
这又说明医院社工的身份一开始就是“一脚搭两 船”。
1/27/2017
讨论，

刘岚，孟群，（2010） • 医务社会工作者的专业背景存在共性，即医学背景 浓厚，绝大多数为医、技、护人员转岗而来，且护 理人员居多，社会学专业背景人员极少？缺少社工 基本技能训练 • 医院将是我国医务社会工作最基础、最主要，也是 最核心的服务领域? 不适用于广东 • 化解医患纠纷是当前医务社会工作的最佳介入点? 提高谈判能力 • 医务社会工作者没有合法身份，医务社会工作发展 缺乏政策法规的支持，开展医务社会工作的医疗机 构都感到孤立无援，举步维艰！加强法制教育
刘继同：医务社工范围
Levels of Intervention 1 2 3 4 5 6 7 8
Holistic Health, Global Hygiene and Environmental Protection Positive Mental and Spiritual Health Behavioral Health Mental Health Preventive and Primary Health care Hospital Care and Treatment Disaster and Emergency Response, Financial Assistance Population, Public Hygiene, Family and Community Health

ຫໍສະໝຸດ Baidu
是院中人也是院外人

1905 伦敦有七家医院聘用了医院社工， 社工用 表现说明了存在的价值。
在美国东岸

1905 MGH 聘用了 Garnet Pelton
She worked from a desk located in the corner of the corridor of the outpatient clinic for 6 months and resigned after developing tuberculosis...
6.
cont.
1.
Basics of health care financing, including Medicare, Medicaid and private insurance
• Hollis, 1964. Casework a Psychosocial Therapy; • Turner, 1978. Psychosocial Therapy
• Community Organization and Social Action Model • Goldstein , 1996. 社区组织与社会行动模式
理论演变 post modern
• Social Ecological (Life) Model 社会生态模式 • Carel Germain, 1984. Social Work Practice in Health Care an ecological approach • Positive Health Model 正向健康模式

可见社工的默默与伟大

Ida Cannon 接替了她的工作，并致力全美推广， 被誉为医院社会工作的创办人。 1913， 在美国有200家医院聘用了医院社工。

信医生还是社会学家

1918 American Association of Hospital Social Workers (AAHSW) 成立 于 Kansas. • Hot debate: 应向医学还是社会工作靠拢？

new foci: preventive and emergencies • MIC Maternity and Infant Care 母婴健康 • behaviour, cognitive, family systems, Crisis and group
我国医务社工发展轨迹
医院：推力拉力 刘岚，孟群（2010）
Evidence-informed approaches to health care; including, the PCMH , integrated primary and
5.
behavioral health care,ACOs and the chronic care model
New health care policies, regulations and delivery system changes resulting from the ACA
2.
3. 4. 5. 6.
Grief, loss and bereavement
Addiction, depression, anxiety, and other mental health conditions Sexual functioning Essentials of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Basic medical terminology Counseling and behavioral change intervention
1920, HHASW 进 行 研 究 , 调 查 596 名 医 院 社 工 ， （Davidson, K. & Clarke, S. , 2014) • 48% 有社工文凭 • 70% 读过社工课程 但同时有 • 38% 有护士文凭 • 86% 读过护理课程


专业角色如何定位？
第一个医务社工课程
1）历史发展 2）社工推进
基层健康： 1）赤脚医生 2）计划生育 3）戒毒禁毒
3）公关管理
4）医患纠纷 5）复康医学
4）荣军照顾 4）工会企业关怀
理论演变
• Medical Model 医疗（生物医学）模式 • Mary Richmond, Social Diagnosis • Psychiatric Model 心理治疗模式 • Psychoanalysis • 1930-40 Advance of and Freudian approach and psychiatric social work • Psychosocial Model 社会心理模式
• Martin Seligman, 2008. Positive Health, Applied Psychology, 57, 3-18.
新的培训要求

预防
推广健康知识 社区优势 增权 社区资源整合 社会能力建设
1986: 提出有18 知识领域
From 1980 to 1987, the faculty of the Social Work in Health Care Program of the Massachusetts General Hospital Institute of Health Professions (IHP) were charged with the responsibility of developing specialized curricula for social work in health care [4]. The challenge was to focus on and revise the generic social work core curriculum to meet the needs of health specialists. A 2-year grant from the Lilly Endowment supported these curriculum development efforts.