LOOKING AHEAD: SOCIAL WORK AS A CORE HEALTH PROFESSION

In the face of mounting fiscal pressures, social workers in health may often find themselves on the defensive. This article argues that social work's key challenge is to become a core rather than an ancillary health profession and identifies areas in which a predominant position for social work services may be achieved. With the advent of the 1980s, the health care system in the United States entered a period marked by serious concern over escalating costs, and both patients and health care providers are now feeling the pinch of fiscal constraints. Battles over standards governing hospitals ' participation in the Medicare and Medicaid programs have challenged social work to delineate the importance of its contribution to health care. As budget cuts threaten staff and programs, social workers have all too often been forced into a defensive posture and circumstances in which holding ground or minimizing losses becomes a victory. In this kind of environment, the pressing daily realities involved in the struggle to protect the profession's concerns inevitably win out over the seeming luxury of plan-ning for the growth of social work in the health care field for the remainder of the decade. However, it is just such planning and vision that are needed to move social work ahead toward leadership in the health field. As Lurie pointed out, "forecasting practice is a step in influencing its future through the suggestion of innovation and change."! The key issue challenging social workers in health is that social work must become a core rather than an ancillary health pro-fession. 2 Few would disagree that social work has made great gains in confirming the usefulness of its contribution to health care. Nevertheless, decisions to cut social work services in the face of limited budgets repeatedly underscore the reality that social work continues to be seen as a supplemen-tary service in the health field. Because a supplemental service by definition remains a discretionary item and a luxury in hard times, social work is inevitably forced to defend and redefend its right to be includ-ed among the health professions. Social work in health will grow and prosper only to the extent it succeeds in moving away from its ancillary position to one that is central