CHAPTER TWO
A HISTORY OF HELPING
CHAPTER GOALS
2. To explore the changing beliefs about who is “less fortunate” and how those
beliefs shaped the definition and treatment of needs throughout history.
3. To examine the emergence and growth of the human service movement.
. To summarize the influence of managed care. 5. To review the increase and
decline of federal involvement in the 20th and 21st centuries, as indicated by needs,
legislation, and reform.
CHAPTER OBJECTIVES
At the end of the chapter, students will be able
1.2 To trace the historical development of helping
2.2 To describe the evolution of human needs since the Middle Ages.
2.4 To apply three 19th century philosophies about human needs to a human service
problem today.
3.2 To identify the significant legislation that supported the development of human
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4.1 Define “managed care.”
5.1 To trace U.S. government involvement in human services in the 20th
century.
5.3 To summarize the conditions that led to the decline of government involvement in
the last 30 years.
READINGS
Introduction to Human Services – Chapter 2
Introduction to Human Services: Cases and Applications – Chapter 2
CHAPTER SUMMARY
Chapter Two presents a history of helping and human services. The history of
helping begins with the early treatment of the mentally ill, the first definitions of mental
illness, and the early church’s service to the poor. Slowly the government assumes some
responsibility for those in need. Examples are the Elizabethan Poor Laws passed in Great
nineteenth century as Dorothea Dix and others educated the public about the poor
treatment of the mentally ill. This chapter also describes the roots of child welfare, the
organized charity movements, and the settlement house movement.
The twentieth century was an era of reform for human services. Clifford Beers,
significant contributions to the human service movement and set the stage for
deinstitutionalization. Programs established under the leadership of Presidents John
Kennedy and Lyndon Johnson targeted poverty, civil rights, and health insurance to
improve the lives of all Americans.
Since the 1960s, the human service movement has grown rapidly. New training
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administration continued during the Ford administration. In addition to an emphasis on
mental health/illness, President Carter reorganized the government, resulting in the
creation of the Department of Health and Human Services.
Managed care is a term that describes a set of tools or methods designed to
change the ways in which we manage resource and deliver human services. It developed
resulted in the passage of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003. This legislation provided outpatient prescription drug
benefits for individuals on Medicare. In addition, George W. Bush initiated efforts to
utilize faith-based and community-based organizations in providing human service
delivery.
CHAPTER OUTLINE
I. Early history
A. The treatment of mental illness was based upon the belief that it was caused
by evil spirits
B. Hippocrates used the scientific approach to diagnose mental illness
C. The church provided help for the needy
F. The Elizabethan Poor Laws described the services available
1. Began the welfare bureaucracy
3. Identified 3 groups of “have nots”
II. Human services in the United States
A. Colonial America
1. Four principles were used to define relief
a. Relief is a public responsibility
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c. Family members have responsibility
d. There is special care for children
2. Institutions were established in the colonies as an initial way to meet
human needs
III. The 19th century: A time of change
A. Social philosophies
1. An emphasis on individualism, laissez-faire economics, and Social
B. Probation
1. The concept of “friendly supervision” was an early form of probation.
C. Mental Illness
2. By the late 19th century treatments and facilities were improved and
included the provision of aftercare and outpatient services
D. Child welfare
1. Children were one of the largest groups of the neglected and needy
E. Reform movements
2. The settlement house movement served immigrant populations in large
cities
IV. Early 20th century: New directions
A. The mental health movement
B. Increased federal involvement
1. The Great Depression created an economic situation that increased the
number of individuals who needed help
2. The Social Security Act of 1935 was the cornerstone of the reform of
this era
a. provided public assistance, social insurance, and health and
c. government guaranteed protection from economic instability
V. Mid 20th century: Expanding the social welfare system
A. Legislation
2. Joint Commission on Mental Illness and Health proposed a national
mental health program and a new type of mental health work
B. Serving those in Need
1. Kennedy and Johnson administrations continued commitment to mental
health and treatment of mental illness
3. Scheuer Subprofessional Career Act of 1966 developed programs to
train poor people and minorities to work with mentally ill
C. The Human Service Movement
1. Training programs established in 1960 to prepare human service
workers for community-based programs
3. Professional human service organizations for human service education
are founded
VI. Late 20th century: Revising the social welfare system
A. Presidential Leadership
1. Richard Nixon’s administration marked a decline in federal spending
and a different way of managing human service programs
3. Jimmy Carter created the Department of Health and Human Services
and established the President’s Commission on Mental Health
4. Bill Clinton passed the Personal Responsibility and Work Opportunity
Reconciliation Act in hopes of reforming the welfare system.
B. Dismantling the Welfare System
1. Voters elected to governmental positions individuals who reduced the
federal budget and decreased involvement in human services
2. Shift in provision of human services occurs
a. Number of nonprofit and private agencies in human services
b. Housing, prisons, and other human services contracted to
private sector
VI. Managed care
A. The influence of managed care
2. Patients’ bill of rights address right to know, confidentiality, choice,
and treatment issues.
B. Managed care and the human service professional
1. Emphasis on case management
3. Use of gatekeepers
VII. Welfare reform
A. Policies and Procedures
1. The Personal Responsibility and Work Opportunity Reconciliation Act
replaced AFDC
2. Welfare reform included key components: state control, work
requirements, time units, and penalties
B. Evaluation of welfare reform
2. Challenges remain with both the implementation and evaluation of
welfare reform
VIII. Legislative changes
A. Medicare Prescription Drug, Improvement, and Modernization Act of 2003
provides outpatient drug benefits on Medicare, Part D.
B. President George W. Bush promoted faith-based initiatives as partners with
federal government
INTRODUCING THE CHAPTER
1. Divide the class into five groups. Assign each group a significant historical event in
Middle Eastern history. Ask each group to list the needs that people had during that time
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2. The following list of people have made significant contributions to the field of human
services: Dorothea Dix, Ronald Reagan, John Kennedy, Benjamin Rush, Jane Addams,
LEARNING ACTIVITIES
Historical Perspective
Students may have limited historical perspective about social problems and sometimes
are unaware how quickly the problems and proposed solutions change from one decade
Once the group has chosen the problem to be addressed, ask each member of the group to
browse newspapers and periodicals of one of the following years: 1988, 1968, 1948,
1928. During their review, the students should try to answer the following:
1. Could you find many articles on the subject?
2. What was the focus of the articles?
4. Identify the issues.
6. What seems to be the predominant human service concerns during this year?
After the students have completed their research, ask them to share it with their
classmates in their group. Ask each group to compare their findings across the years.
Then ask the students to group themselves according to the years they researched. What
seems to be the common themes by year? How did the years differ?
The Development of Human Services
One way to learn about the development of human services is to interview a helping
professional who has been involved in human service delivery for five years or more.
READING AND STUDY GUIDE: READ, REVIEW, APPLY
The following questions are useful as a guide to the students’ reading.
1. Prior to the Middle Ages, what were the causes of and treatments for “evil
spirits”?
determine the status of an individual’s mental health?
4. What was the major impact of the Elizabethan Poor Law of 1601?
5. How did the Elizabethan Poor Law of 1601 characterize the needy?
6. What were the four principles of the Elizabethan Poor Laws that influenced
human services in colonial America?
8. What was Benjamin Rush’s contribution to the treatment of the mentally ill?
9. Name three approaches to helping children in need.
10. What two significant events in the early 1900s had a major impact upon the
history of helping?
11. What was important about the development of social work?
12. Describe Clifford Beers’ experience as a mental patient?
13. List the major components of the Social Security Act. Why was it important to
the support of those in need?
17.. Define the “Great Society”. What was its purpose?
18. What was deinstitutionalization? How did it influence the development of the
human service movement?
20. Define managed care.
22. What does gatekeeping mean in managed care?
23. Trace the dismantling of the welfare state in the United States.
25. Identify the major human service challenges as we enter the 21st century.
The following questions will help students in their review of the chapter.
2. Trace the role of the church and the role of the government during the Middle
Ages and immediately following the Middle Ages.
4. What role did institutions play in the development of human services?
5. Trace the development of care for the mentally ill and children from the 1850’s to
the 1930’s. How did the care change? Why did it change?
6. Explain the impact of the Great Depression on helping those in need.
7. Trace the federal government’s involvement in human services from the 1930’s to
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9. In what ways has major legislation influenced the development of human
services?
10. How will the passage of the Patient Protection and Affordable Care Act impact
human services?
The following exercises allow students to apply what they have learned from the
chapter.
1. Select a problem that your country is facing today (homelessness, poverty, etc.).
Based on your knowledge of Presidents Roosevelt, Kennedy, Johnson, Nixon,
Carter, Ford, Reagan, George H.W. Bush, Clinton, and George W. Bush, how do
you think each of their administrations would address this issue?
2. Construct a time line of human service events between 1946 and the present in the
3. Divide students into groups. Each group works for an agency or organization that
4. Re-create the case of Almeada and baby Anne in Chapter1. Re-write the case as
if Barb La Rosa worked for a managed care organization. Critique the results.
TEST ITEMS
Multiple Choice
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1. Until the Middle Ages people believed that mental illness was caused by the
presence of _____________ in the body.
2. Hippocrates, a doctor in the third century B.C., was one of the few professionals
who believed that problem behavior was a function of
3. Relief for the poor was the responsibility of which provider during the Middle
Ages?
4. New ways of assisting those in need during the Middle Ages was prompted by all
EXCEPT
5. All of the following are features of the Elizabethan Poor Law EXCEPT
6. The dramatic change in the care of the mentally ill that occurred by the end of the
18th century and resulted in more humane treatment is known as
7. The colonists used which of the following as a model for meeting the needs of
indigents, idlers, criminals, orphans, and others?
8. Proponents of laissez faire economics and Social Darwinism discouraged human
service provisions by the
9. The concept of “less eligibility” was introduced in 1834 to
10. By the 1850s, special institutions for the blind, the mentally ill, criminals, and
other groups were established because of the belief that
11. Immigration from abroad and migration from rural to urban areas during the latter
half of the 19th century led to a period of
12. Large houses in slum areas that served as community centers housed workers
known as
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d. volunteers
13. The settlement house movement is best known for its belief that
14. Significant developments in the early 1900s, a period known as the sociological
era, included all EXCEPT
15. Protection from economic instability and an expansion of welfare activities
characterized
16. The beginnings of the human service movement can be found in the impact of all
EXCEPT
17. The Joint Commission on Mental Illness and Health made two recommendations
that directly affected the human service movement
18. To help states develop programs for increased training, research, and practice,
legislation to improve mental health created the
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a.* National Institute of Mental Health
b. Joint Commission on Mental Health
c. Department of Health, Education, and Welfare
d. Action for Mental Health initiative
19. The idea behind the passage of the Community Mental Health Centers Act of
1963 was to
20. Human services flourished under all but ONE of the following presidents
21. Promoting the rights of the poor, improving employment opportunities for
minorities, and eradicating poverty were the goals of the
22. President Carter involved five departments in reorganizing the federal executive
branch to include two new departments
23.. All but ONE of the following are questions asked during external review prior to
the delivery of services
24. Managed care has influenced human services by
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25. Human service professionals can improve their relationship to managed care by
26. Confidentiality in the managed care setting is an issue because
27. The establishment of professional human services organizations served many
purposes including
28. A major component of the Welfare Reform Legislation in 1996 was to
29. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003
was passed to
30. Terrorism, partisanship, and economic instability are challenges
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c. major concerns of Democratic administrations.
d. that will be resolved by legislation.
Discussion
1. Describe the role of the church in the early history of human services.
3. Explain the forces behind major changes in attitudes toward the role of human
services in nineteenth century America.
5. Analyze the impact of 20th century legislation and presidential administrations on
service delivery.
7. Compare the values that provide the foundation for the Social Security Act of
1935 and the 1996 welfare reform legislation.
8. What are the advantages and disadvantages of managed care for human services?
10. Identify the challenges that remain and their relationship to human services.
