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word “psychologist,” although the license was often limited or the title qualified. Another thirteen boards licensed people with masters’-level training in psychology under another title.

The profession scored a major coup with the passage of the Omnibus Budget Reconciliation Act of 1987, which included a provision allowing for direct Medicaid and Medicare reimbursement of the services of clinical psychologists furnished at rural health clinics and community mental health centers (Omnibus Budget Reconciliation Act, 1987).

Social Workers Origins of the Profession

In the United States social work developed in two directions: (1) the expanding involvement of social workers in service programs supported by governmental and non-profit agencies to address the needs of individuals and families and (2) the organization of social work as a profession (Austin, 1984). Participation of social workers in service agencies started in the 19th Century and expanded through the mid - 20th Century to meet the social welfare needs of immigrants, poor persons, and persons with psychiatric needs. Organization of social work as a profession included development of professional schools, journals, conferences, and membership associations. The professionalization of social work helped to meld together social workers working in diverse settings, including settlements, hospitals, schools, charity agencies, and psychiatric clinics (Austin, 1984). Social work also provided career opportunities for educated women.

The search for a single underlying framework for social work has been elusive throughout the last century. As Austin observes, social work is a blend of professional practice activities clustered in three areas, dealing with problems of (1) poverty, (2) social care, and (3) acute mental health treatment. Most social workers identify with one of these three traditions, each with its own history and conceptual framework. Social work practice dealing with problems of poverty began with charity societies and settlement houses tracing back to the late 19th Century. Social work practice taking up social care began with institutional reforms of Dorothea Dix in Massachusetts in the mid 19th century; the development of children's homes and foster homes; and early forms of psychiatric hospitals, schools for persons with retardation, and juvenile correction institutions (Austin, 1984). Social work practice in acute mental health treatment emerged early in the 20th Century, spurred by the development if outpatient clinics attached to psychopathic hospitals, treatment of shell-shocked World War I veterans, and the growth of child guidance clinics around 1920. Social work was taught at the psychiatric social work training program at Smith College, funded by the Red Cross.


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