The organization of a sociological department in a hospital conducting an out-patient clinic must make provision primarily for social work contributing to diagnosis and treatment. The routine duties may be divided into (a) securing histories, (6) follow-up work, (c) social case work. These duties may be performed by different workers or united in any combination in one worker; but it is important that the three forms of service should be distinguished, in order that each receive due attention.
A social worker in attendance at the out-patient clinic takes a history from the patient as a basis for the medical examination, and at the same time inquires into his social condition to discover environmental difficulties calling for social treatment. The same worker will see that patients and friends accompanying them understand the physician's directions and are disposed to follow them. For history taking in the hospital, a special worker, who by practice becomes expert, is of great assistance to the medical staff.
By follow-up work is meant keeping informed by a card system of the failure of patients to keep their appointments and inducing them, by letter, telephone, or visit, to report. This might seem to be merely clerical work, but it will be found to require fine judgment and the interest and point of view of the social worker, the results obtained being in proportion to the presence of these factors.1 By this service also a patient dismissed by the physicians for six months or a year may be automatically brought back at the end of that time or reported upon by the social worker, if unable or unwilling to make a visit. The follow-up work for syphilitic patients is especially important. Another form of follow-up work is a routine method of seeking the relatives of all patients with a positive Wassermann reaction and bringing them to the clinic for examination.2
As nearly every case of mental disorder presents some problem of social maladjustment, a routine social examination of every admission should be made. Where the social staff is insufficient, which is almost invariably the case, the determination of the need of social care is necessarily left to the physicians, who refer cases to the social service. But the physician is not accustomed to look for social disorder nor familiar enough with social practice to know the possibilities of social care; so that he is likely to refer only cases of social disorder that are conspicuously acute or urgent.
The amount of time required for social case work is proportionately greater than the time required by medical work, for the patients under social care are widely scattered in the community and may need more or less close attention for months or years. As no hospital has yet a staff of social workers even approximately adequate for the work, there is a method in use of classifying social cases as either "intensive " or "slight service" cases according to the degree of responsibility assumed by the social service. "Slight service" cases are those in which assistance is given without inquiry beyond the apparent facts. In an intensive case the social service attempts to assume responsibility for making a full inquiry into the social condition of the patient and his family, and endeavors to secure the largest measure of social well-being possible for both patient and family.
1 E. E. Southard. Report of the Director of the Psychopathic Department of the Boston State Hospital, 1917.
2 E. E. Southard. Report of the Director of the Psychopathic Department of the Boston State Hospital, 1918.
It has been estimated that 75% of all admissions will call for some form of social attention, which 25% may receive from social agencies in the community, so that 50% should receive social care from the social service of the hospital. As a social worker can not care for more than 100 to 150 cases a year adequately, a worker is needed for every 200 to 300 admissions.