In 1965, Titles XVIII and XIX of the Social Security Act were passed, creating Medicare and Medicaid and laying the foundation for U.S. healthcare policy. Originally, Medicare was created to meet the specific medical needs of adults aged 65 and older. In 2022, individuals with end-stage renal disease, amyotrophic lateral sclerosis (ALS), and other disabilities may also receive Medicare, regardless of age. Medicaid was established to provide a basic level of medical care to specific categories of people who are poor, including pregnant women, children, and the aged. As of 2010 as part of the Affordable Care Act (ACA), states are provided with the opportunity to expand Medicaid to close the coverage gap for public health insurance. This entry provides explanations of Medicaid and Medicare and associated social healthcare programs in the United States. An overview of significant programming developments and trends, future directions, challenges, and controversies as of 2021 are also provided.
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Medicaid and Medicare
Victoria M. Rizzo, Sojeong Lee, and Rebekah Kukowski
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Mental Health Courts
Matthew Epperson, Julian Thompson, and Kelli E. Canada
This article discusses the emergence, structure, and purpose of the mental health court. It details the therapeutic aspects of the mental health court and its function as a specialized-treatment court serving persons with serious mental illnesses in the criminal justice system. Guiding themes, such as the criminalization of mental illness, therapeutic jurisprudence, and drug-treatment courts are described. It also identifies key legislation that contributed to the funding and proliferation of mental health courts. The effectiveness of mental health court, along with current criticisms regarding its impact on participants’ mental health and recidivism outcomes, are also covered. Last, social work values and the various roles of social workers in the mental health court are highlighted to demonstrate the relevance of mental health court to contemporary social work practice and intervention.
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Mental Health Policy Overview
Christine M. Rine
Mental health practice is inextricably linked to how this concept has been understood in a historical context from which policies and systems of care develop. How mental health is perceived has shaped policy, as much as policy has influenced how mental health has been defined and subsequently treated. Early frameworks evolved, furthering the multidisciplinary nature of policies and services highlighting social and environmental contributions. Holistic approaches that appreciate social determinants are a comparatively new way to understand and advance mental health policy that underlies access to insurance, programs, and services based on qualifications and eligibility. A chronological and historical overview highlights interconnectedness and provides context to the development of mental health policies, initiatives, and systems of care. Content specific to roles of the social work profession should be included.
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Military Social Work
Kelli Godfrey and David Albright
Although there are many definitions of military social work, this article primarily focuses on social work by uniformed personnel within the United States military. Social work with military and veteran-connected populations is also done by civilian professionals.
The history of military social work in the United States is rooted in the civilian professional social work community and is a microcosm of that sector. Military social work has a rich history of providing services to military men and women and their families during periods of peace, conflict, and national crises. Military social workers have been involved in humanitarian operations and have participated in multinational peace-keeping operations. Social work in the Army, Navy, and Air Force is tailored to the mission of their particular service. However, joint operations between the services are becoming more frequent. Military social workers adhere to the National Association of Social Workers (NASW) code of ethics while providing service to an institution with its own unique culture, standards, and values. The role of military social workers has expanded since the Global War on Terrorism began, in 2001.
Military social work encompasses a wide variety of skills, performed by social workers who are both civilian and military, ranging from crisis to working with families. Military social work is unique and often faces ethical dilemmas even though military social workers still follow the National Association of Social Workers’ Code of Ethics. The history of military social work dates back to the early 1940s, but has evolved with the needs of military members and their families. The Army, Air Force, and Navy all have social workers, both civilian and those who wear the uniform. Due to the number of veterans and military families living throughout the United States, and seeking care in community settings, recommendations to establish competencies for social workers working with military and veteran-connected populations is underway.
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The Movement for Black Lives
Troy D. Harden and Aislinn Pulley
The phrase “Black Lives Matter” has become an identifiable phrase across the globe. Accelerated by social media in an online platform and social action, it is marked by a mass of not only Black folks, but a multiracial collective that has also manifested in direct action protests against police violence toward Black people. Initially a hashtag, #BlackLivesMatter, the phrase emerged into one of the most significant social movements in modern times. The Black Lives Matter Movement, along with the term Movement for Black Lives (M4BL), has centered on the historically ignored killings of Black men, women, and youth at the hands of state-sanctioned violence in public discourse, and offers an inclusive approach to organizing for social change.
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National Association of Social Workers
Elizabeth J. Clark
The National Association of Social Workers (NASW) is the largest membership association of professional social workers in the world with nearly 145,000 members. Formed in 1955 by uniting seven predecessor organizations, NASW has a dual mission of protecting and advancing the profession of social work and of advocating for social justice issues. The NASW national office is based in Washington, DC, with chapters in each state, Puerto Rico, Guam, and the Virgin Islands. There are also separate chapters in New York City and metropolitan Washington, DC, as well as an international chapter for U.S. social workers living abroad.
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Neoliberal Managerialism and the Human Services
Mimi Abramovitz and Jennifer Zelnick
Neoliberalism emerged in the United States in the mid-1970s in response to the second economic crisis of the 20th century. Seeking to undo the New Deal enacted in response to the 1930s economic collapse, neoliberalism redistributes income upward and downsizes the state using tax cuts, budget cuts, privatization, devolution, and reducing the power of social movements. Privatization, a key neoliberal strategy, is typically understood as shifting responsibility for entitlement programs such as Social Security or Medicare from public to the private sector. Managerialism (i.e., the adoption of business principle and practices) refers to operationalization privatization within human service agencies. The growing dominance of managerialist productivity, accountability efficiency, and standardization has redefined the landscape of the human services The troubling impact on service provision, working conditions, and the well-being of human service workers leads us to ask if the social work mission will become a casualty of managerialism.
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Organizational Governance
Mindy R. Wertheimer
Most human service organizations are identified by the U.S. Internal Revenue Service as charitable nonprofits, designated as 501c3 organizations. They are overseen by governing boards, which ensure that all the activities of the organization contribute to advancing its mission while it remains accountable to stakeholders.
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Outcome Measures in Human Services
Bruce Friedman and Rosario Olivera
The field of social work transformed over time from providing relief to less fortunate individuals to a sophisticated profession that looks at evidence-based measures to deliver change. This has been possible by looking at accountability aspects to demonstrate improvement by addressing performance outcomes resulting from interventions. Outcomes operate on all levels from micro to mezzo to macro, and the skills needed include identifying who is being served and the specific goals to be achieved. This article introduces the use of a logic model as a way to explain interventions and outcomes on a short-term, intermediate term, and long-term basis. The section also describes current measures being used to demonstrate how outcomes are used to justify the practice.
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Out-of-School Suspension of African American Youth and Progressive Education Alternatives
Wendy Haight and Priscilla Gibson
Racial disproportionality in out-of-school suspensions (suspensions) is a persistent, multi-level social justice and child well-being issue affecting not only youth, families, and schools but society as a whole. It is a complex, multiple-level social problem that will require an equally complex response. The design of effective remedies will require adequate understanding of the problem as well as the historical and sociocultural contexts in which it emerged and is perpetuated. Progressive educators have offered a number of alternatives to harsh and exclusionary discipline, but research is needed to examine their effectiveness, especially in reducing racial disproportionalities.
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Peace
Charles D. Cowger
This entry discusses the relationship of war and peace to social work practice. The historic and current mandate for social workers to work for peace is presented. The inevitable tie of war to everyday social work practice is described, and the relationship between social justice and peace is illustrated.
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Pension and Retirement Programs
Robert B. Hudson
In the American retirement income picture, private pensions occupy a critical but underused place. Roughly one-half of Americans do not have private pension coverage, and those who do not tend to be concentrated in the lower levels of the overall income distribution. Pension coverage and adequacy are reviewed here as is the place of private pensions in assuring income adequacy in old age. Pressures on Social Security and “traditional” pensions will make the place of defined contribution (401k-type plans) increasingly important to older individuals, including social workers.
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Philanthropic Foundations
Marcus Lam and Helmut K. Anheier
Foundations are private institutions for public benefit. With a long history that reaches back to antiquity, inside the United States and globally, foundations are a growing organizational form that policy makers increasingly view with both potential (as a source of private funds to complement government services) and caution (given their autonomy and low level of accountability). Alongside the rise in commerce and finance, foundations experienced an initial growth period in the late Middle Ages and a second in the late 19th and early 20th centuries, following the Industrial Revolution. Political stability, an increase in demand for social, educational, and cultural services of all kinds, and economic prosperity are certainly significant factors behind this growth. Since the dawn of the 21st century, foundations have remained the primary legal structure through which newly minted and emerging wealthy individuals practice their philanthropy. The foundation form, or some similar iteration, is growing not just in many Western democratic countries but even in communist and other political regimes such as China and Russia. The reason for this growth is the way in which foundations have been envisioned as instruments of welfare state reform in the broadest sense. This growth implies a more important role for foundations as providers of relief to those most in need, protectors of traditional institutions and the status quo, and, to a lesser extent, as change agents. In particular, this is apparent among the “new philanthropists” of the 21st century, drawn from technology entrepreneurs, who are more actively engaged in public policy.
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Philanthropic Funding for Human Services
Kirsten A. Grønbjerg
Of the 1.75 million tax-exempt organizations registered with the Internal Revenue Service in April 2020, about one-third are human service nonprofits, including about 267,000 charities with about $371 billion in total combined revenues. In 2019, human service public charities (excluding private foundations) received an estimated $56 billion in charitable contributions. This represents 12% of all charitable contributions, and is about 21% of the combined revenues reported by the almost 270,000 registered human service public charities reporting financial information. While government funding is a major driving force for human service charities, philanthropic funding clearly is important as well. Securing such funding requires solid understanding of the fundraising process and dedicated time and effort. However, competition for donations (and fundraising expertise) appears to be growing across the board, with donations from individuals, United Way, and corporate contributions most at risk for human service charities. These trends in philanthropic funding reflect growing income inequality, which also impacts the scope and types of human services needed and is complicated even further by persistent racial disparities.
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Philanthropy
Jerry D. Marx
Philanthropy can be defined as the voluntary effort to increase the well-being of humankind. It includes the giving of money, time, or other resources to charitable organizations. Philanthropy is especially important in the United States, because of the nation's emphasis on private initiative and minimal government in promoting societal well-being. The profession of social work has its roots in the development of a more scientific approach to philanthropy. In the aftermath of the Great Recession of 2008, social workers have faced increased challenges in soliciting donations to human service charities.
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Policy Practice
Angela S. Henderson and Angela Bullock
The everchanging influence of policy in addressing social problems and societal conditions greatly contributes to the vital need for macro and social policy practice in social work. Social policy practice based on specific macro social work nature, values, approaches, and processes includes problem-solving interventions and strategies for the protection and advancement of human well-being. Thus, social policy practice enhances and challenges the social work profession’s delivery, examination, and evaluation of social justice through policy development and analysis, planning, and implementation.
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Political Ideologies and Social Welfare
Mimi Abramovitz
Political ideologies developed to address “social problems” shape public policy debates, social policy strategies, and social work practice. The clashes among the long-standing political traditions—conservatism, liberalism, and radicalism—reflect fundamental and often irreconcilable differences regarding social, economic, and political life. Ideology also shapes theories of racial and gender inequality. These ideological perspectives and theories diverge on several core issues that underpin social welfare provision, including human nature, the role of the market and the state, definition of social problems, and the role of the welfare state. The resulting distinctions provide social workers with a framework to more effectively assess and change social welfare policies.
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Political Interventions
Megan Meyer
Since the Progressive Era, social workers have played important roles in political struggles and social movements for social justice. They have advocated for, designed, and implemented an array of domestic and international social policies and have increasingly campaigned for and held political office. Even so, there has been considerable ambivalence within the profession about the extent to which social workers should engage in political action, considered by some to be “radical” social work. A major challenge facing the profession during the 21st century is to ensure that social work programs and associations prepare students and practitioners to understand the impact of political processes on their and their clients’ lives and to develop the skills to identify the forms of political intervention that are effective for different goals and different political, social, and economic contexts.
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Political Process and Youth Empowerment
Jason Anthony Plummer
The political process refers to how individuals and groups make their concerns known to political actors. The animating force of the political process is social power. To that end, social workers should acquire political knowledge (e.g., factual understanding of voting rights) and critical analysis skills (e.g., an awareness of how social inequalities affect political outcomes) in order to support their clients’ and communities’ engagement in the political process.
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Political Social Work
Suzanne Pritzker and Shannon R. Lane
Political social work navigates power in policymaking and politics to elicit social change. It is grounded in core social work values and ethics, including the professional responsibility to challenge systemic discrimination and institutional inequalities through political action. Political social workers address systemic barriers to social, political, economic, and racial justice, and engage in political action to promote individual and communal well-being through policy processes and outcomes. This article discusses the five domains of political social work: engaging individuals and communities in political processes; influencing policy agendas and decision-making; holding professional and political staff positions; engaging with electoral campaigns; and seeking and holding elected office. It also examines social workers’ political activity in the United States and globally, the role of social work education, and challenges for political social work, including the profession’s legacy of supporting injustices and tensions around the role of political social work, and identifies opportunities to address these barriers.
