Public Health Social Work module by Kathleen Rounds MSW, MPH, PhD and Maria Gallo Goals Lecture Notes Annotations Additional resources Suggested Activities GOALS OF THE CLASS To present an overview of the history and philosophy of social work and public health; To familiarize students with the roles and functions of public health social workers; To explain the different levels of prevention and to give examples of possible interventions for each level of prevention by public health social workers; and To examine the role of public health social work in relation to 3 issues Prenatal care; Children with special health care needs; and Adolescent pregnancy prevention LECTURE NOTES History of Social Work: Major Trends and Periods Charity Organization Societies (1870 and beyond) Major economic depression in the 1870’s. COSs were created to organize the public and private charities that had proliferated during that period. COSs attempted to apply principles of scientific charity while avoiding the pitfalls of dependency and pauperism. Avoided dispension of direct relief. Registries (paper and pen version of management information systems). "Friendly visitor model" was often paternalistic. Friendly visitors were upper-class, well-educated women. This model contributed to the development of the profession by recognizing the need for more than well-meaning volunteers to address the problems of urban poverty. Settlement Movement (1890 - 2000) Severe depression in the 1890’s. Strikes. Poor people’s march on Washington. Mass migration. ¾ of NYC lived in squalid, overcrowded tenement. Movement called for new approach to poverty. Focused more on causes of poverty rather than flaws of the individual. Hull house in Chicago and Jane Adams most well-known examples. Settlement work involved: Research - systematic documentation of the problem. Reform - rather than treat the poor individually, settlement workers concentrated on changing general conditions or situations that they uncovered through their surveys. Residence - college students moved into the neighborhoods to live where they worked. Dirty streets and inadequate refuse services propelled some Hull House residents into local politics (i.e., advocacy and policy making); created basic services in communities (e.g., kindergartens, playgrounds, neighborhoods.) The Progressives (1900 - 1917) Continued the reform that came as the Settlement Movement matured. In NY, the Settlement House put social workers in public schools; developed school lunch program; anti-tenement groups struggled for better housing; women’s labor movement. Strong commitment to research and publishing findings. For example, publicized the working conditions of women and children; the number of kids in orphanages; and infant mortality and maternal mortality rates. At the White House Conference on Children in 1909, called for a national agency to deal with these issues and in 1912 the Children’s Bureau was formed. Sheppard-Towner Act of 1922 provided funds to local health departments for maternal and infant health services. Campaign for widow’s pension to avoid the removal of children from the homes of single parents. A national committee was formed on Child Labor but this problem wasn’t eliminated until the New Deal. The Professionals By 1920’s people were tired of reforms. The Settlement Movement lost its momentum. Public sector jobs and social casework became the core of the profession and the focus shifted to the individual. Mary Richmond wrote her text, Social Diagnosis. Specialization within the field of social work. Medical social work arose out of Mass General and concern for what happens when patients were discharged. Psychiatric social work was the leading edge of social casework in the 1920’s. The strong link to psychiatry and Freudian theory improved social work’s status and image. Many social workers felt that the new dominance of psychiatric social work helped shed the profession of its stigmatizing attachment to the poor. School social work. In the 1920’s social casework was a major force in social work. Crisis (1929 - 1940) The trauma of the Great Depression changed the way that people thought about poverty. Social work took its place on the stage. F. D. Roosevelt as governor of NY and later as president had a number of very talented social workers on staff who drafted the New Deals programs (e.g., unemployment legislation and public works projects). Birth of Social Security programs - the most important piece of social legislation in this century. Unemployment insurance Workers compensation Social Security Title V programs which included Maternal Child Health programs The creation of Social Security pushed many social workers into administrative roles of these new programs. Recommitment to reform More working class into the profession Civil Rights/The Great Society Tackled issues of social justice Used community organizing and community planning techniques. For more on history see http://www.boisestate.edu/socwork/dhuff/XX.htm or http://www.naswdc.org History of Public Health: Major Trends and Periods Infectious Diseases (prior to early 20th century) Infectious diseases were most pressing public health concern (e.g. tuberculosis, pneumonia, influenza, streptococcal infections, measles, chickenpox, small pox, typhoid fever). Public concern because infectious diseases affected wealthy as well as poor. Specific etiologic agents were unknown; public health workers related infectious diseases to urbanization and industrialization. Citizen sanitary associations addressed overcrowded living conditions, uncollected garbage, lack of sewerage systems. Creation of health departments and boards of health. Kept birth and death records to track diseases. Focused on sanitary engineering, environmental hygiene, and quarantine. Age of Bacteriology (early 20th century) Bacteria discovered to cause infectious diseases. Was impetus for professionalization of public health field because trained public health personnel were needed to operate bacteriological laboratory. 1913 State laws created requiring public health officers to have specialized training. Rockefeller Foundation report called for establishment of science-based schools of public health. Linked to medical schools but distinct. Public health schools were to train diverse spectrum of personnel (not just physicians) and to give them a common professionalism. Replacement of the nonspecific sanitation work with targeted strategies for specific routes of disease transmission. Examples: Treatment of bacteria in water Milk pasteurization Mosquito eradication to prevent spread of yellow fever Vaccinations to prevent diseases "New Public Health" (20th century) A. Began to address issues besides communicable diseases. Public health now included: Health education Promotion of preventive health examinations Maternal and child health Establishment of well-baby clinics with home-visiting services Education for mothers on diet, child care, and living conditions Detection of treatable but unrecognized impairments Public health nurses tested children in schools to detect eye problems and other physical impairments. Major causes of death shifted from communicable diseases to cardiovascular diseases and cancer People living longer because not dying of infectious diseases Increased wealth allowed people to engage in unhealthy behaviors (e.g., less physical labor, fatty diets, cigarette smoking, alcohol use. Public health focused on identifying environmental, behavioral, and social risk factors for chronic diseases and developing population-based interventions for reducing these risk factors. Example of interventions: Population-based screenings for asymptomatic but treatable conditions (breast cancer, cervical cancer, hypertension, and hypercholesterolemia) Linkages to medical services Counseling high-risk individuals Promoting conditions in the community that facilitate following medical advice. For example public health personnel supported interventions to reduce the use of tobacco (e.g., cigarette taxes, advertisement restrictions, smoke-free zones) Surveillance Outreach and enabling services Contact-tracing Environmental detoxification Mass immunizations Separation of Public Health and Medicine (Post-World War II) Differences Clients Medicine - focus on individuals Public health - focus on populations Services Medicine - diagnosis, treatment, biological mechanisms of disease Public health - prevention, non-biological determinants, safety-net primary care Scientific basis Medicine - biology, chemistry, physics Public health - epidemiology, biostatistics, social sciences Practice sectors Medicine - private, self-employed, solo or group practices Public health - organizations (usually governmental) Payment Medicine - fee-for-service or cost basis Public health - fixed budgets B. Expansion of Medicine Dramatic growth Specialization - American Board of Medical Specialties recognized 70 subspecialties in 1992. Great advances in "high-tech" curative practice, biomedical practices Public and policies encouraged this emphasis on diagnostic and therapeutic therapies rather than on preventive services C. Public Health Development Grew at slower rate - public health accounted for only 2.7% of nation’s health dollars in 1990. Public and policymakers - public health not as important as medicine Communicable diseases now controlled through vaccinations and antibodies. Own successes made it more difficult to gain support. Absence of disease more difficult to perceive than developed conditions Free-market society encourages medical care over prevention Prevention of chronic diseases require social and environmental conditions to change. Difficult politically (e.g., opposition from tobacco companies). Curative easier than prevention. Focus shifted to safety-net services for un- and under-insured people. This now accounts for 2/3 of state public health budgets. In 1960’s public health’s scope was limited by government beginning to create new agencies for specific issues (e.g., environmental control, water quality, air pollution control, occupational safety, substance abuse, mental health). (Adapted from Lasker, R. D., 1997) Current Era In the 1988 report, The Future of Public Health, the Institute of Medicine critically assessed the public health system’s status. Defined the "core functions" of public health and stated that the current system was incapable of fulfilling these functions.http://www.apha.org/ppp/science/10ES.htm Different formulations of the core functions of public health had been written by various organizations. Finally, in 1994, a single consensus list of core functions and essential services was developed by a work group comprised of representatives from Association of State and Territorial Health Officials, National Association of County and City Health Officials, Institute of Medicine, Association of Schools of Public Health, Public Health Foundation, National Association of State Alcohol and Drug Abuse Directors, National Association of State Mental Health Program Directors, and Public Health Service http://www.apha.org/ppp/science/10ES.htm Core Functions Assessment The regular collection, analysis, and sharing of information about health conditions, risks, and resources in a community. Policy Development Uses assessment data to develop local and state health and social welfare policies and to direct resources toward those policies. Assurance Focuses on the availability of necessary health services throughout the community. It includes maintaining the ability of both public health agencies and private providers to manage day-to-day operations as well as the capacity to respond to critical situations and emergencies. http://www.apha.org/ppp/science/10ES.htm Essential Services Monitor health status to identify community health problems. Diagnose and investigate health problems and health hazards in the community. Inform, educate, and empower people about health issues. Mobilize community partnerships and action to identify and solve health problems. Develop policies and plans that support individual and community health efforts. Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services and ensure the provision of health care when otherwise unavailable. Assure a competent public and personal health care workforce. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. Research for new insights and innovative solutions to health problems. http://www.apha.org/ppp/science/10ES.htm Public Health Social Work Characteristics Focus on causes as well as consequences Appreciate the unique characteristics of client populations as well as the individuality of clients Includes a population focus that subdivides into relative-risk categories Pays attention to the denominator (those not yet affected but at risk of becoming so) as well as the numerator (those already affected) Seeks to understand the factors that keep persons well in addition to factors that contribute to poor health (risk and protective factors) Focus on prevention of social and health problems Orientation to long range strategies Concerned with understanding the cause, nature, and the extent of the problem (epidemiology) Ability to plan and implement interventions at many levels Ability to function on an interdisciplinary team in an inter-organizational community context Adapted from: Hall, W. T., & Young, C. L. (1982). Social work in the field of public health. In D. S. Sanders, O. I. Kurren, & J. Fischer (Eds.) Fundamentals of Social Work Practice: A Book of Readings, (pp. 215-221). Belmont, CA: Wadsworth. Watkins, E. (1985). The conceptual base for public health social work. In A. Gitterman, R. B. Black, & F. Stein. Public Health Social Work in Maternal and Child Health: A Forward Plan. Young, C. L. (1987). Family planning utilization by black and white women: Public health social work implications. Social Work In Health Care, (13)2, 93-109. Levels of Prevention Primary Prevention Focus on preventing the disease or condition from ever occurring. Health promotion and protection. Secondary Prevention Early diagnosis and treatment. Focus on delaying or averting the condition after its onset. Tertiary Prevention Prevention of further disability and deterioration. Focus on rehabilitation or restoring the client to improved functioning after the full onset of the disease or condition. Adapted from Gitterman, A., Black, R. B., & Stein, F., 1985, p. 22. 10 Essential Public Health Services to Promote Maternal and Child Health in America Assess and monitor maternal and child health status to identify and address problems. Diagnose and investigate health problems and health hazards affecting women, children, and youth Inform and educate the public and families, about maternal and child health issues. Mobilize community partnerships between policymakers, health care providers, families, the general public, and others to identify and solve maternal and child health problems. Provide leadership for priority-setting, planning, and policy development to support community efforts to assure the health of women, children, youth and their families. Promote and enforce legal requirements that protect the health and safety of women, children, and youth, and ensure public accountability for their well-being. Link women, children, and youth to health and other community and family services, and assure access to comprehensive, quality systems of care. Assure the capacity and competency of the public health and personal health workforce to effectively address maternal and child health needs. Evaluate the effectiveness, accessibility, and quality of personal health and population-based maternal and child health services. Support research and demonstrations to gain new insights and innovative solutions to maternal and child health-related problems. Friedenberg, L. A., & Grason, H. (1997). Public MCH Program Functions Framework: Essential Public Health Services to Promote Maternal and Child Health In America. Maternal and Child Health Bureau. Prenatal Care Why PHSW Issue Prenatal care can reduce the incidence of low birthweight. Mothers who received no prenatal care are three times more likely to have low birthweight babies than mothers who received first trimester care. http://www.mchb.hrsa.gov/healthys.htm Low birthweight (LBW) is less than 5 pounds, 8 ounces (2500 grams). Very low birthweight (VLBW) is less than 3 pounds, 5 ounces (1500 grams). Birthweight is important because LBW infants are 40 times more likely to die during their first month than normal-weight infants. http://www.modimes.org/HealthLibrary2/factsheets/Teenage_Pregnancy_Fact_Sheet.htm Other Risk Factors for LBW Poor nutrition For an explanation of this factor, see http://www.mchlibrary.info/pubs/default.html http://www.cdc.gov/nccdphp/drh/datoact/pdf/rhow9.pdf Smoking For an explanation of this factor, see ftp://ftp.cdc.gov/pub/Publications/mmwr/wk/mm4343.pdf Alcohol or other drug use For an explanation of this factor, see http://www.cdc.gov/nccdphp/drh/ih_iimorb.htm Stress For an explanation of this factor, see http://www.modimes.org/HealthLibrary2/factsheets/Stress_and_Pregnancy.htm Risk Markers Young maternal age For an explanation of this marker, see http://www.cdc.gov/nccdphp/drh/pdf/teenbrth.pdf Minority racial status For an explanation of this marker, see http://omhrc.gov/rah/ For a racial/ethnic breakdown. see http://www.cdc.gov/nchswww/datawh/statab/pubd/hus-t11h.htm Low education level For an explanation of this marker, see http://www.aecf.org/kidscount/kc1998/findings.htm#birthwt The Institute of Medicine’s Committee to Study the Prevention of Low Birthweight (1985) identified 6 major barriers to obtaining prenatal care: Lack of insurance or inadequate insurance; Lack of maternity care providers to care for low-income high-risk women; Inadequate prenatal services in the sites which high-risk women access (e.g., community health centers, hospital outpatient clinics, health departments); Beliefs, attitudes, and experiences among women which discourage accessing prenatal care; Lack of transportation and child care services; and Inadequate systems to provide care to hard-to-reach women. Activity: One of the essential function of PHSW involves the elimination of these barriers to obtaining access to prenatal care. What specific interventions might be employed for each barrier? (Hint: see Healthy Start http://www.healthystartassoc.org/ Healthy Start is an initiative funded by the Maternal and Child Health Bureau to decrease the incidence of infant mortality.) Statistics 1 in 5 women did not receive timely prenatal care in 1996, according to a report by the U.S. Department of Health and Human Services, The Initiative to Eliminate Racial and Ethnic Disparities in Health. http://raceandhealth.hhs.gov/ Percent of teen mothers (ages 15-19) who received first-trimester prenatal care versus all mothers according to CDC’s National Vital Statistics Report (Vol. 47, No. 4). Teen mothers 67.1%% (1996) All mothers 82.5% (1997) http://www.cdc.gov/nchswww/fastats/prenatal.htm Racial/ethnic percentage breakdown of mothers who received first-trimester prenatal care in 1997 according to the CDC’s National Vital Statistics System, All Races 82.5% Black 72.3% Hispanic 73.7% White, Non-Hispanic 84.7% http://www.cdc.gov/nchswww/fastats/pdf/47_4tb9.pdf According to the CDC’s National Vital Statistics System, 7.39% of all live births were LBW babies in 1996. This was the highest rate since the 1970’s. Black 13.01% of all live births were LBW White 6.34% Hispanic 6.28% American Indian / Alaskan Native 6.49% Asian / Pacific Islander 7.07% http://www.cdc.gov/nchswww/datawh/statab/pubd/hus-t11h.htm E. The infant mortality rate (death before first birthday) was 7.3 per 1000 live births in 1996. Black 14.2% White 6.0% Hispanic 6.1% American Indian / Alaskan Native 10.0% Asian / Pacific Islander 5.2% http://www.childstats.gov/ac1999/hlth4.htm Public Health Social Work Providing Essential Public Health Services to Promote Maternal and Child Health A. Prenatal Care: Case Example In Ohio, social workers who were providing direct services to clients noted disparities between the infant mortality rates for black and white women. (Assess and monitor maternal and child health status to identify and address problems.) Social workers held a statewide conference on "Black and Minority Health." This conference resulted in the Governor establishing a task force to research the disparity. (Assure the capacity and competency of the public health and personal health workforce to effectively address maternal and child health needs.) The Black and Minority Task Force discovered that the black infant mortality rates were roughly twice that of white infants. The high infant mortality rates were attributed to low birthweight and premature births. (Diagnose and investigate health problems and health hazards affecting women, children, and youth.) These findings prompted the State Division of Maternal and Child Health to form a Social Work Task Force to evaluate the current service delivery system and to develop a plan for addressing the psychosocial factors affecting the black infant mortality rate. The Task Force includes social work educators, planners, clinicians, administrators and consultants. (Evaluate the effectiveness, accessibility, and quality of personal health and population based maternal and child health services. Provide leadership for priority-setting, planning, and policy development to support community efforts to assure the health of women, children, youth and their families.) Adapted from Stokes, D. In Morton, C. J., & Hirsch, R. G. (Eds.), 1988 Activity: How does the Ohio case model illustrate public health social work characteristics?   Adolescent Pregnancy Why PHSW Issue Teens are more likely to have low birthweight babies than adults. The infant mortality rate for babies born to teens (under age 20) is about 50% higher than the rate for those of adult mothers (older than 20). Children born to teen mothers suffer higher rates of abuse and neglect. Teen mothers were less likely to complete high school or receive a GED within 2 years of the date when they would have graduated (64%) than teen women who do not have children (94%). About 80% of teen mothers eventually receive welfare. Children born to teen mothers are more likely to have inadequate health care, less likely complete high school, and more likely to live in poverty. Teen parents less likely to provide their child with good nutrition, health care, cognitive and social stimulation. http://www.aecf.org/kidscount/teen/index.htm Statistics In 1996, the teen birth rate was 54 per 1000 teens (ages 15-19). This was a 12% decrease from 1991. However, the rate was still slightly higher than 10 years ago. The U.S. has a teen birth rate higher than any other industrialized country. 1996 race/ethnicity breakdown of teen birth rate: Non-Hispanic White 38 per 1000 teens (ages 15-19) Black 91 Hispanic 102 22% of teen births were repeat teen births (1996). 76% of teen births occurred to unmarried teens (1996). Teens received inadequate prenatal care in 10% of the teen births (1996). 1996 race/ethnicity breakdown of percentage of teen births where teens received inadequate prenatal care: Non-Hispanic White 7% Black 13% Hispanic 13% http://www.aecf.org/kidscount/teen/index.htm Adolescent pregnancy prevention - Levels of Prevention Matrix Biological Biomedical research to develop birth control options. Biomedical research to develop reliable pregnancy test. Biomedical research to improve health outcomes for teen mothers and their infants. Individual Educating teens on risk factors and abstinence & birth control use. Ensuring the availability of condoms and birth control. Provision of psychosocial services to help teens change risk-taking behaviors. Early pregnancy screening. First trimester prenatal care. Prenatal counseling. Encouraging abstinence from drugs. Screening & treatment for genetic disorders. Educating teens on birth control options to prevent repeat teen births. Referrals to support groups, psychosocial, health care & case management services. Environmental Developing pregnancy prevention programs at the local, state, and federal levels. Developing pregnancy prevention education materials. Coalition building/legislative action to ensure adequate funds and programs are available for research and education. Identifying high-risk teen pregnancies. Developing age appropriate pregnancy care & counseling. Developing better medical and social service programs for pregnant teens. Providing continuing education for providers. Ensuring confidentiality for teen clients. Legislative action to ensure that all clients can afford medical care. (Adapted from Henk, M. L. 1989.) Activity: Choose a pregnancy prevention program from your community or from the program models identified by the Resource Center for Adolescent Pregnancy Prevention http://www.etr.org/recapp/programs/index.htm. What are the interventions used? Are these primary, secondary, or tertiary prevention interventions? If these interventions do not address each of the three levels of prevention, what other interventions could be included?   Children with special health care needs Why PHSW Issue PHSW works to improve outcomes through increasing protective factors and decreasing risk factors for children with special health care needs. Risk and protective factors: Specific disability Ex.: The type and severity of primary disability could increase the risk of developing secondary conditions. Relationship with primary caregiver Ex.: If parents’ emotional state prevents them from bonding with the infant, the child may lose opportunities for optimal development. Parental substance abuse Ex.: Parents who abuse substances may not be capable of providing for the child’s needs. Poverty Ex.: Poverty may lead to inadequate nutrition, lack of access to medical care, and inadequate housing. Each of these factors can exacerbate the primary disability. Also the stress of poverty may negatively impact the relationship between parent and child. Secondary conditions Ex.: Peer relationships may suffer if the peers do not understand the child’s disability. Adequacy of resources available to the family Ex.: Families with inadequate resources are less likely to actively participate in interventions to promote the child’s development. Parents’ sense of efficacy Ex.: Parents with a strong sense of efficacy are more likely to advocate for their child and to take an active role in planning and implementing services. (Zipper & Simeonsson, 1997) Statistics At least 6.1% of children (ages 0-18) have a disability. Prevalence (in 1000’s) of conditions Visual impairment 83 Hearing impairment 190 Speech impediment 335 Learning disabilities 167 Mental retardation/Down syndrome 786 Absence of loss 18 Paralysis 140 (Cerebral paralysis) 99 Deformities 134 (Spina bifida) 17 Orthopedic Impairment 144 Other and ill-defined impairments 69 (Zipper & Simeonsson, 1997) 7% of children (ages 5-17) have limitation on activities (going to school, playing, child activities) because of chronic condition (1995). http://www.ChildStats.gov/ac1998/aifr.pdf Poverty effect - Disabilities are more common in children in poverty 12% of children (ages 5-7) living below poverty level have a disability. 7% of those living at or above the poverty rate have a disability. This is an increase from 1984 when 9% living below poverty had a disability vs. 6% at or above poverty rate. http://www.ChildStats.gov/ac1998/aifr.pdf Cultural Factors How individuals and families think about having a chronic illness or disability influences the processes and outcomes of life events. A family’s beliefs influence how they define a child’s illness or disability, as well as their development of coping strategies. These processes impact psychological outcomes. A family’s interpretation and beliefs about a given condition have an impact on health behavior, including the decision to seek medical care, cooperation with medical treatment, and relationships with health providers. Most people develop their understanding of health from a common sense understanding of illness based on personal experience, the media and folk and alternative models of medical care. Cultural beliefs play a major role in determining family and community attitudes towards a person with a chronic illness or disability. Different ethnocultural perspectives influence treatment choices and family roles. Conflict and misunderstanding can occur between family caregivers and providers when their beliefs collide. From Garwick, A. W., Kohrman, C. H., Titus, J. C., Wolman, C., Blum, R. W. Variations in families’ explanationsof childhood chronic conditions: A cross-cultural perspective (In press). http://www.peds.umn.edu/centers/ihd/CHIPage1.html Jan%20%2797.pdf Activity: Use an example to explain one of the cultural factors which affect children with special health care needs. (Hint: http://www.mchb.hrsa.gov/cshcnmc.html) ANNOTATIONS Combs-Orme, T. (1990). Social work practice in maternal and child health: An orientation. In Social work practice in maternal and child health (pp. 1-23). New York: Springer. This introductory chapter of the book gives a basic overview of the field of maternal and child health (MCH). Discusses the necessary knowledge base for MCH social workers including theoretical perspectives (e.g., public health, pp. 2-4); practice roles (needs assessment, pp. 12-13); and important terms. Outlines epidemiological risks involved in MCH. Farel, A. M. (1994). Needs assessments in maternal and child health programs. In H. M. Wallace, R. P. Nelson, & P. J. Sweeney (Eds.), Maternal and child health practices (4th ed., pp. 141-148). Oakland, CA: Third Party. Overview of the three steps of need assessments: 1.) identify the problem; 2.) define the problem by gathering data; and 3.) determine the resources necessary to correct the problem. Discusses factors that influence identification of problems, information sources for defining the problem, and broad categories of need. Fickling, J. A. (Ed.). (1993). Social problems with health consequences: Program design, implementation, and evaluation. Proceedings of the BiRegional Conference for Public Health Social Workers in Regions IV and VI. Columbia: University of South Carolina, College of Social Work. Collection of 12 presentations resulting from this annual conference sponsored by the Bureau of Maternal and Child Health. Articles treat topics in Maternal and Child Health; program design, implementation, and evaluation; and social work practice with rural and culturally diverse populations. Includes a review by E. Watkins on the role public health social workers have played throughout the history of maternal and child health.   Fuchs, J. A. (1995). Planning for community health promotion: A rural example. In J. Rothman, J. L. Erlich, & J. E. Tropman (Eds.), Strategies of community intervention: Macro practice (5th ed., pp. 308-314). Itasca, IL: F. E. Peacock. Describes a rural county’s experience in planning for community health promotion using the Planned Approach to Community Health (PATCH), a program of the Division of Health Education of the CDC. Outlines five phases: 1.) community organizing; 2.) data collection and analyzes; 3.) problem identification and prioritizing; 4.) planning intervention strategies; and 5.) program evaluation. Lists the benefits of using this approach to plan and coordinate community health promotion.   Gitterman, A., Black, R. B., & Stein, F. (Eds.). (1985). Public health social work in maternal and child health: A forward plan. Proceedings of the Working Conference of the Public Health Social Work Advisory Committee for the Bureau of Health Care Delivery and Assistance. Washington, DC: Division of Maternal and Child Health. The Forward Plan has the goal of identifying the issues and priorities which are crucial to promoting maternal and child health in the United States. J. Evans explained the conference’s purpose and goals, and E. Watkins laid the theoretical basis for the sessions. Conference sessions covered four topics: "Public health social work priorities in maternal and child health"; "Standards for public health social work"; "Knowledge and skill requirements for social work practice in maternal and child health"; and "Collaboration between schools of social work and public health." Each sessions began with a conceptual paper, continued with a presentation, and concluded with the formation of workshop recommendations.   Halverson, P. K., Nicola, R. M., & Baker, E. L. (1998). Performance measurement and accreditation of public health organizations: A call to action. Journal of Public Health Management Practice, 4(4), 5-7. Discusses the benefits of establishing performance measurements and accreditation of public health organizations and describes possible benefits of their implementation. Includes information on current state involvement with setting performance measures and accreditation. Henk, M. L. (1989). Public health role. In M. L. Henk (Ed.), Social work in primary care (pp. 113-126). Newbury Park, CA: Sage. Public health social work is defined as how one practices and not where one practices. Public health social work should begin with the assessment of the collective patient population rather than the individual patient’s needs. Discusses interventions for patient and environment throughout the course of the disease process. Also explains a five-step problem-solving process: 1.) assessment of needs; 2.) target interventions; 3.) prioritizing interventions; 4.) planning intervention strategies; and 5.) evaluating the effectiveness of the interventions. Matrix for identifying primary, secondary, and tertiary interventions.   Insley, V. (1998). Social work in public health and medical care: My experience with multi-disciplinary, multi-cultural, multi-method prevention and treatment. Washington, DC: Author. Autobiographical work by one of the pioneers in the field of medical and public health social work. Virginia Insley’s career included social work positions in hospitals; federal, regional, state, and local health departments; and in the positions of chief social worker in the Health Services of the U.S. Children’s Bureau and chief of social work in the U.S. Public Health Service. She has been attributed with advancing the field of public health social work and with promoting the needs of specific populations.   Institute of Medicine. (1988). The future of public health. Washington, DC: National Academy of Press. "Public health is what we, as a society, do collectively to assure the conditions for people to be healthy" (IOM, 1988, p. 19). This study of public health concluded that the current system is in "disarray." This assessment is based on the gaps in knowledge for many public health issues; the lack of consistent technical expertise; and the lack of attention to management as a technical skill. The authors reaffirm the important role of public health by giving examples of current problems and crises that can only be addressed by collective action. Recommendations are made regarding public health’s mission; the role the government plays in achieving that mission; and the various responsibilities held by each level of government.   Jaros, K. J., & Evans, J. C. (1995). Maternal and child health. In R. L. Edwards (Ed.), Encyclopedia of social work (19th ed., Vol. 2, pp. 1683-1689). Washington, DC: NASW Press. Briefly discusses MCH history and the current role of the federal government. Overview of state, local, and other MCH organizations. Explains categories of emphasis including children with special health care needs, genetics, research, and evaluation. Outlines contemporary MCH issues including adolescent health, injury prevention, pediatric AIDS, and reduction of infant mortality. Concludes with the role of social workers in MCH.   Kelley-Lewis, J. (Ed.). (1997). Change and challenge: MCH social workers make the difference. Proceedings of the BiRegional Conference for Public Health Social Workers in Regions IV and VI. Columbia: University of South Carolina, College of Social Work. Collection of presentations from this annual conference sponsored by the Bureau of Maternal and Child Health. The conference aimed to give a historical and contemporary view of public health social work practice; teach current innovative interventions for work with at-risk MCH groups; discuss the role of social work in addressing biopsychosocial MCH issues; and provide an opportunity for MCH social workers to network. Includes the keynote speech by Joseph Telfair on the roots on community social work.   Lasker, R. D. & the Committee on Medicine and Public Health. (1997). Medicine and public health: The power of collaboration. New York: The New York Academy of Medicine. Monograph on collaborative efforts between public health and medicine. Reviews the history of both disciplines. The authors studied 414 cases of collaboration between the medicine and public health sectors. Six types of collaboration are described with case examples given for each. Concludes with recommendations for initiating or improving collaborations. Also available at http://www.nyam.org/pubhlth   Minkler, M. (Ed.) (1998). Community organizing and community building for health. New Jersey: Rutgers, The State University. Critically analyzes the theory and practice of community organizing and community building (e.g., issue selection and participation, mapping of community capacity, and healthy community assessment). Uses case studies to give concrete application of the methods and concepts (e.g., substance abuse, HIV/AIDs, and lead poisoning). Discusses ethical considerations of the practice of community organizing and building.   Minkler, M., & Wallerstein, N. (1997). Improving health through community organizing and community building. In K. Glanz, F. M. Lewis, & B. K. Rimer (Eds.), Health behavior and health education: Theory, research, and practice (2nd ed., pp. 241-269). San Francisco: Jossey-Bass. Community organization is the "process by which community groups are helped to identify common problems or goals, mobilize resources, and in other ways, develop and implement strategies for reaching the goals they collectively have set" (p. 241). Community building is "an orientation to the ways in which people engage together in the process of community change" (p. 241). This chapter discusses main ideas of community organization and community building as related to health education, the history of the field, the idea of community, and examples of community organization and community building.   Morton, C. J., & Hirsch, R. G. (Eds.). (1988). Developing public health social work programs to prevent low birthweight and infant mortality: High risk populations and outreach. Proceedings of the 1987 Public Health Social Work Institute. Berkeley: University of California at Berkeley. Collection of presentations from this conference sponsored by the Bureau of Maternal and Child Health. Speakers addressed the topic of eliminating disparities in birth outcomes; MCH policy and programs; providing outreach with under-served populations; developing public health social work programs; or ethical issues for MCH administrators.   Poole, D. L. (1995). Public health social work: Pro bono publico [Editorial]. Health and Social Work, 20(4), 243-244. In response to those who blame "liberal intellectuals for drift and discontent in America." Discusses the Ad Hoc Committee on Education for MCH Social Work Practice in the Year 2010 and the deficiencies identified in social work education. Commends South Carolina's Office of Public Health Social Work as an outstanding example of quality public health social work.   Poole, D. L. (1997). Building community capacity to promote social and public health: Challenges for universities [Editorial]. Health and Social Work, 22(3), 163-170. Focuses on the role of universities in fostering community capacity. Community capacity is "the characteristics of communities that affect their ability to identify, mobilize, and address social and public health promotion/education. Stresses the importance of sensitivity to the complex natures of individual communities.   Poole, D. L., & Van Hook, M. (1997). Retooling for community health partnerships in primary care and prevention [Editorial]. Health and Social Work, 22(1), 2-4. Outlines six characteristics of community health partnerships, giving examples for each one. These include involving community members; providing "coordinated health services in accessible community sites"; emphasizing "community ownership of health problems and solutions"; and creating "new structures to integrate traditionally fragmented systems of care." Also lists the skills needed by social workers to participate in such partnerships.   Resnick, C., & Tighe, E. G. (1997). The role of multidisciplinary community clinics in managed care systems. Social Work, 42(1), 91-98. Historical and contemporary role of social workers in community clinic movement. Managed care systems allow community clinics to service those who otherwise might not receive care. Discusses two roles for the social work interdisciplinary team member: implementing biopsychosocial screenings and activating communities. The Vine Hill Clinic is given as an example of the creative and appropriate use of social work expertise. Rosenberg, G., & Holden, G. (1999). Prevention: A few thoughts [Editorial]. Social Work in Health Care, 28(4), 1-11. Calls for social workers to focus on preventive, population-based work. Stresses the importance of non-medical, health promotion interventions. Identifies sources for obtaining data on the cost-effectiveness of prevention. Discusses literary evaluations of prevention interventions.   Rosenberg, G., & Holden, G. (1997). The role of social workers in improving quality of life in the community. Social Work in Health Care, 25(1/2), 9-22. Explores the role of social work in relation to the community in the context of changes in health care. Discusses the concept of quality of life. Outlines five service domains for future social work including "identification and intervention with vulnerable populations - especially with primary prevention" and "utilization of social epidemiological techniques to improve screening, assessment, and evaluation."   Rounds, K., Zipper, I. N., & Green, T. P. (1997). Social work practice in early intervention: Child service coordination in a rural health department. In T. S. Kerson (Ed.), Social work in health settings (pp. 111-129). New York: Haworth Press. Social work case example of a teen mother and her infant with special health care needs. The case is explored in the context of policy, technology, and organization. The authors briefly describe the legislation which affected the infant's access to care; the way in which technology has affected infants with special health care needs; and the organizational structure of the services available to the mother. The social work practice decisions are explained in this context.   Science, Practice, and Policy: Community Strategies for Health http://www.apha.org/science/innovations/pubs/chs.html A guide to developing strategies to achieve the goals of Healthy Communities 2000 and improve the health of your community. Advises on gaining support and creating collaboration among the community’s leadership, civic and religious organizations, businesses and employees, and local media. Explains social marketing and community mobilization concepts. Clarifies the role of Model Standards, APEXPH, and PATCH.   Science, Practice, and Policy: The Guide to Implementing Model Standards http://www.apha.org/science/innovations/pubs/theguide.html This guide explains the use of Model Standards which were developed by APHA and the CDC to enable communities to achieve the Year 2000 National Health Objectives set forth in Healthy People 2000: National Health Promotion and Disease Prevention Objectives. This publication also describes the use of the Assessment Protocol for Excellence in Health (APEXPH) and Planned Approach to Community Health (PATCH). These two tools can assist in implementing the Model Standards.   Science, Practice, and Policy: Media Relations http://www.apha.org/science/innovations/pubs/mediare1.html A concise guide for public health agencies or others who are interested in working with the media in order to disseminate health information to the community. Offers practical suggestions on topics such as writing new releases, framing the story, choosing spokespeople, obtaining coverage for the issue, and developing a good relationship with the media.   Syversen, E. L. (Ed.). (1998). Future of maternal and child health: Implications for academic program development: Summary report. Arlington, VA: National Center for Education in Maternal and Child Health. Summary of this meeting hosted by the New York Medical College Graduate School of Health Sciences and the National Center for Education in Maternal and Child Health. The goals of the meeting were to assess the current status of the MCH field and plan the future of MCH graduate education. Issues revolved around establishing MCH competencies; assessing MCH resources; improving partnerships; improving communication; promoting an interdisciplinary approach; and defining and marketing MCH.   Turnock, B. J. (1997). Public health: What it is and how it works. Maryland: Aspen Publishers.   U.S. Department of Health and Human Services. (1988). Health care practice today: The social worker as educator. Proceedings of Columbia University School of Social Work Conference. The conference consisted of five workshops centered on the topic of social workers as educators. Participants discussed creative means for educating clients as well practice issues and dilemmas. Included suggestions for overcoming obstacles to holding the role of educator. Concluded with recommendations for academia and agencies to assist in developing social workers capacity for educating others.   Zipper, I. N., & Simeonsson, R. J. (1997). Promoting the development of young children with disabilities. In M. W. Fraser (Ed.), Risk and resilience in childhood (pp. 244-264). Washington DC: NASW Press. Discusses the difficulties of defining and assessing disabilities among young children and of collecting and classifying data on this population. Presents data on the prevalence of disabilities. Using an ecological framework, the authors explore the risk and protective factors for children with disabilities. These factors include the type of disability, relationship with primary caregiver, parental substance abuse, poverty, secondary conditions, adequacy of resources available to the family, and the parents’ sense of efficacy. Concludes with a consideration of the implications for prevention and early intervention.   ADDITIONAL RESOURCES WEB RESOURCES Administration for Children and Families http://www.acf.dhhs.gov/ U. S. Department of Health and Human Resources Administration. Describes the Administration's programs (e.g., Head Start, Office of Family Assistance, and Administration on Developmental Disabilities.) Explains the programs’ missions, eligibility requirements, and related policy developments.   Agency for Health Care Policy and Research http://www.ahcpr.gov/ Information on improving the quality of health care, reducing the cost, and improving access to health care. Also provides Spanish-language bulletins on various health issues.   Agency for Toxic Substances and Disease Registry http://atsdr1.atsdr.cdc.gov:8080 Environmental health advisories and information. Links to the newsletter, Hazardous Substances & Public Health.   American Public Health Association http://www.apha.org Equips advocates with fact sheets on current public health issues; provides an archive of APHA news releases; includes sections on policy, practice and science issues; and links to public health resources.   Association of Schools of Public Health http://www.asph.org Lists ASPH accredited public health schools. Defines public health and describes areas of concentration. Offers information on internships and job opportunities.   Association of Maternal and Child Health Programs (AMCHP) http://www.amchp.org National organization promotes research and develops policy on MCH issues. Provides issue briefs and fact sheets, including one entitled, The Impact of the State Child Health Insurance Program (CHIP) On Title V Children With Special Health Care Needs Programs (http://www.amchp1.org/chip-fnl.html).   Association of State and Territorial Health Officials http://www.astho.org/ Non-profit public health organization develops policy and programs on issues such as access to care; environmental health; infectious diseases; prevention; and public health information and infrastructure. Centers for Disease Control and Prevention http://www.cdc.gov/ Agency of the U.S. Department of Health and Human Services. Some of the CDC’s functions involve public health surveillance, research, health statistics, public health services, and health communications. The CDC publication An Ounce of Prevention is a cost analyst of 19 public health prevention strategies.   Environmental Protection Agency http://www.epa.gov/ U.S. agency charged with protecting the environment and human health. Includes information on child environmental health topics as well as links to other relevant resources.   Food and Drug Administration http://www.fda.gov U.S. consumer protection agency that regulates the safety of food, cosmetics, and medicines. Site includes information on new drugs and facilitates the surveillance of medicines through the MedWatch program.   Health Care Financing Administration http://www.hcfa.gov U.S. agency which administers Medicare, Medicaid, and Child Health Insurance Programs (CHIP). Site includes program information, publications, and reports.   Health Resources and Services Administration http://www.hrsa.dhhs.gov/ Links to HRSA’s offices and bureaus (e.g., Office of Minority Health, HIV/AIDS Bureau, Maternal and Child Health Bureau.) Information on the structure of HRSA.   Healthy People 2000 http://www.odphp.osophs.dhhs.gov/pubs/hp2000/default.htm National initiative to improve the health of Americans through prevention. Three hundred specific objectives were established in 22 priority areas in order to drive and measure action. Gives progress review information and links to information on the development of Healthy People 2010 http://web.health.gov/healthypeople/default.htm   Department of Health and Human Services http://www.hhs.gov Describes the DHHS and the department’s agencies. Gives DHHS and congressional updates. The Healthfinder provides links to online health information.   Indian Health Service http://www.ihs.gov Agency within the DHHS responsible for providing health services to American Indians and Alaskan Natives. Overview of the agency and its medical programs. Links to other American Indian-related resources.   National Information Center for Children and Youth with Disabilities http://www.nichcy.org/ Provides information on disabilities and related topics. Makes referrals to parent groups, professional associations, and disability organizations.   National Institutes of Health http://www.nih.gov Federal biomedical research agency within DHHS. Information on clinical trials. Links to The National Library of Medicine http://www.nlm.nih.gov. Provides access to two free systems to search Medline, a database of health journals.   Occupational Safety and Health Administration http://www.osha.gov Department of Labor agency. Site includes information and regulations on workplace safety and health.   Office of Public Health Service http://www.hhs.gov/phs Office within DHHS. Links to offices within OPHS (e.g., Office on Women’s Health, Office of Disease Prevention and Health Promotion, Office on Minority Health). Also links to service agencies (e.g., HCFA, HRSA, NIH).   Weinreich Communications http://www.Social-Marketing.com Links to sites related to social marketing or prevention marketing. Also includes list of free federal publications related to this issue. SUGGESTED ACTIVITIES Choose a public health social work issue. Using M. Henke’s Prevention Matrix, give examples