In the early years of the 20th century, social work's practice boundaries expanded to include direct work with people with the most serious mental illnesses through the function of aftercare. Using complementary and mutually reinforcing efforts to promote social reform in the care of people with mental illness and then to provide that care directly, the young social work profession established its presence in the emerging public mental health field and significantly broadened prevailing standards of acceptable care. This article presents a historical case analysis of the early events contributing to the identification of social work with aftercare and illustrates processes of creating professional "place" while influencing public perception of social needs relevant for the profession's continued growth and influence in the current reconfiguration of human services systems.

Medicare and Medicaid have been in effect for more than three years. This analysis endeavors to assess the impact of these programs on care of the poor and mentally ill aged persons. A significant finding is that Medicare and Medicaid have significantly improved the care of elderly psychiatric patients. Variations and limitations among the states are discussed.

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