Social Work Student and Practitioner Roles in Integrated Care Settings

Healthcare Social Workers' Scope of Practice during COVID-19

The COVID-19 pandemic pushed the U.S. healthcare system to its limits, resulting in the need for flexibility in care delivery. This study aimed to describe healthcare social workers' scope of practice since the start of the pandemic. Semi-structured interviews for this qualitative study were conducted using the Zoom platform between July and August 2020. This study used a basic qualitative content analysis with integrated deductive and inductive coding to explore participant perspectives. Their scope was assessed based on healthcare social work practice standards. Four practice standards and eight themes that emerged from the data were knowledge and skills (care planning and intervention and social worker-patient relationship), workload sustainability (workload expansion and workload facilitators), interdisciplinary collaboration (collaborating beyond the scope of responsibilities and collaboration challenges), and cultural competency (institutional and societal). The findings add a deeper understanding of the roles social workers perform, how they think about these roles, how they want to be understood, and how they are best utilized in ways consistent with their training and expertise. Moving forward, healthcare systems may consider well-delineated roles and responsibilities for everyday practice and during pandemics.

Social workers are key to addressing social determinants of health in integrated care settings

Social workers play an important role in assessing social determinants of health (SDH) and providing behavioral health services in integrated care settings. Evidence suggests that integrated care interventions improve quality of life and other patient outcomes. However, the ambiguous role of social workers on the interdisciplinary team, the lack of protocol in SDH screening and intervention, and restrictions due to healthcare reimbursement limit social workers' ability to intervene. Future directions include standardizing integrated care models, evaluating integrated care's efficacy to address SDH, incorporating SDH into interprofessional training including role clarification and reimbursing for SDH assessment and intervention.

Preparing students to address the social determinants of health in integrated care settings

BACKGROUND

Health professionals are increasingly being called to address the social determinants of health (SDOH) and, to do so effectively, often requires an integrated approach to care. As a result, accreditation standards across multiple professions have emphasised the importance of interprofessional education (IPE).

APPROACH

This paper describes large-scale, community-engaged learning that is required annually of students from nursing, pharmacy, public health, and social work. Through a series of asynchronous and synchronous activities that are informed by the Interprofessional Education Collaborative core competencies, students are trained to be SDOH change makers who can readily adopt integrated care service delivery frameworks into their future practice.

EVALUATION

Approximately 1000 students have participated in this event since the University launched its IPE curriculum in 2017. Student consistently report achievement of the course learning objectives, with 91% of students reporting that the learning activities enhanced their understanding of their professional roles/responsibilities in regards to addressing poverty and food insecurity.

IMPLICATIONS

Two key lessons learned from these efforts are described, including the benefits of a trauma-informed pedagogical approach and special considerations for large-scale learning.

Social workers in integrated care beyond primary care: a scoping review

Social workers are key members of integrated care (IC) teams, yet there is limited research on the presence and roles of social workers on IC teams. Research literature from 2014 to 2021 was identified using the following search engines: Academic Search Complete, PsycINFO, CINAHL Plus, SocINDEX and MEDLINE. An exploratory search was conducted in January 2021 and an updated search was conducted in August 2021. This search resulted in 802 references, 50 of which met criteria for full-text review. Nine articles were identified through supplemental searching. 20 articles were included in the final review. Of the 20 studies included, most were randomized control trials (45%; n = 9). Studies varied across settings including specialty care (40%; n = 8), community-based practices (35%; n = 7), and primary care (25%; n = 5). Social workers engaged in a variety of roles including behavioral interventions, care coordination, and intake assessment. Social workers are engaged in IC in a variety of roles across healthcare settings. Findings suggest that patients' mental health outcomes improve in IC settings which include social workers. Future research is needed to isolate the impact that social workers have in IC. Social workers are key members of integrated care teams, yet there is a need to explore their roles on these teams. Using a methodological approach, research literature from 2014 to 2021 was explored to establish the roles, responsibilities, and settings of social workers on integrated care teams. Of the 20 articles included in the review, social workers held various roles including intake assessment, care coordination, and behavioral interventions, such as psychotherapy or cognitive behavioral therapy. Findings suggest that social workers are on integrated care teams in a variety of roles across various healthcare settings and that patients' mental health outcomes improve in integrated care settings that include social workers.

Health professionals' attitudes on integrated care and social work practice

Research regarding the intersection of social work and integrated care has recently increased. Although research specific to the role and engagement of social workers in integrated care is promising, research regarding attitudes toward social workers on integrated behavioral health (IBH) teams remains scant. This study provides perspective regarding healthcare professionals' attitudes toward the role of social workers on IBH teams. A survey was constructed and distributed to health professionals (n = 104) from medicine, nursing, pharmacy, and social work. Mixed methods were used to evaluate survey findings. Results suggest attitudes toward social workers on IBH teams are generally favorable.

The DNA of Social Work as a Partner in Primary Health Care

There is a strong focus on primary health care (PHC), as rooted in a commitment to social justice and equity, to reduce social inequalities in health. Within PHC, interprofessional collaboration is emphasized to achieve these objectives. Social workers are a renewed partner within these collaborations, as principles of social justice and human rights are the core of this profession. However, it is unknown if and how social work implements these principles in primary health care settings. This systematic literature review examined the existing literature on the role of social work in primary health care settings on themes of social justice. Our results emphasize how valuable the presence of social workers in primary health care is because of their broad perspective on health. At the same time, we also reveal a few points of concern, as their focus on social justice remains rather individual. This review suggests the strengthening of a social justice based approach in primary health care, which is an issue that should be shared with other healthcare professionals. We discuss implications for practice, research and policy.

Using Latent Class Analysis to Understand Social Worker Roles in Integrated Health Care

Purpose: Social work (SW) is a profession that fulfills important roles on integrated health teams, yet there remains a lack of clarity on SW's functions. The current study sought to identify typologies of SW's roles on integrated care teams using latent class analysis (LCA).Method: An electronic survey was developed, piloted, and administered to Masters level SW students and practitioners in integrated health care settings (N = 395) regarding weekly use of interventions. LCA was conducted to estimate latent sub-groups of respondents.Results: Respondents reported an average of 14.6 (SD = 4.7) interventions. Five classes of SW roles were identified and varied by setting and focus. One class (13%) completed a hybrid function providing behavioral health and social care interventions.Conclusions: Classes of SW roles on teams may reflect varying models of integrated care. A flexible SW on the team may adapt to patient and clinic needs, but increases the opportunity for role confusion.

Integrated Behavioral Health and Intervention Models

Accumulating evidence documenting the high percentage of patients who first discuss mental health needs with their primary care physician has accelerated the integration of physical and mental health care to a national priority. Several models have been developed describing how health care settings can integrate physical and mental health care and how training programs might better prepare clinicians to work in integrated behavioral health care settings. This article explores models of integrated behavioral health, highlights contributions of social work and psychology, and describes the training and experiences of social workers and psychologists working in integrated behavioral health.

Overall Work and Practice Satisfaction of Licensed Clinical Social Workers in the National Health Service Corps Loan Repayment Program

Little is known about the job satisfaction of licensed clinical social workers (LCSWs) participating in the National Health Service Corps (NHSC) federal Loan Repayment Program (LRP). Employee satisfaction in organizations is important for organizational well-being and to decrease turnover. A satisfied NHSC LCSW workforce is also important given the array of services it provides, especially in rural and underserved areas. This study examined the work satisfaction of 386 LCSWs participating in the NHSC LRP in 21 states. Rural upbringing, being older than 40 years, and a higher salary were significantly associated with overall work and practice satisfaction. In addition, satisfaction with administration, staff and the practices' linkages to other health providers, the mission of the practice, and connection with patients were strongly associated with overall work and practice satisfaction. To our knowledge, this is the first study to examine the work and practice satisfaction of LCSWs participating in the NHSC LRP, and our findings have the potential to inform the NHSC's strategies in managing and retaining LCSWs.

Understanding Health Talk in Behavioral Health Encounters: A Qualitative Analysis

Although physical and behavioral health conditions commonly cooccur, best practices making behavioral health treatment responsive to clients' health needs are limited. Particularly little is known about how physical health is addressed by clinicians within routine therapeutic treatment. This study describes the frequency and type of health talk occurring within integrated behavioral health sessions, and explores how this talk functions within ongoing therapeutic work. Participants in this study included 51 dyads of clinical social workers (n = 13) and clients (n = 51) receiving therapy within an integrated community health and behavioral health center. Therapy sessions were recorded and transcribed verbatim. Content analysis determined the frequency and content of health talk in sessions. Thematic analysis was used to understand the function of health talk within these visits. Health talk occurred in 92% (n = 47) of sessions. Clients initiated the majority of discussions. Talk about sleep (40%, n = 19), diet/exercise (35%, n = 16), and chronic health conditions (28%, n = 13) were most common. Health talk either complimented or conflicted with therapeutic work, depending on the topic discussed and when it occurred during session. Health talk changed the scope of therapeutic work by integrating care coordination into routine practice. Health talk was pervasive and was frequently initiated by clients, signaling its relevance to clients' recovery. Providers leveraged heath talk to complement their therapeutic work, but these strategies were not universally applied. Care coordination activities were a part of routine therapy. Practice and policy changes that support a more interdisciplinary approach to clinical work are needed.

Prevention, Health Promotion, and Social Work: Aligning Health and Human Service Systems Through a Workforce for Health

The seminal Consensus Study by the National Academies of Science, Engineering, and Medicine released in September 2019 describes the benefits of integrating health and social care service delivery, underscoring the central role of social determinants of health (SDOH) in health outcomes. Although the report's focus on the integration of health and social care contributes a much needed perspective to the national discourse on SDOH and offers a useful framework for organizing service delivery activities, the omission of prevention and health promotion throughout the report is a substantial limitation.We call for increased attention to and investment in prevention and health promotion in the proposed 5As framework. We contend that effectively addressing SDOH and improving alignment between health and social systems require reconceptualization of the traditional health care workforce and renewed state and national advocacy efforts.A paradigm shift encompassing a broader "workforce for health" that is well trained in prevention, health promotion, and advocacy is critical to addressing SDOH, improving population health outcomes, and achieving health equity. Given their professional mission, training, expertise, and scope of practice, social workers are well positioned to lead this effort.

Preparing Master of Social Work Students for Interprofessional Practice

PURPOSE

This study aims to measure growth in interprofessional knowledge, skills, and values in MSW students from three universities who participated in a Behavioral Health Workforce Education and Training program focused on serving children, adolescents, and transition-age youth.

METHODS

Students participated in an interprofessional field placement and specialized educational sessions that addressed interprofessional team-based care, engaging at-risk youth and families, and working with vulnerable populations. The Interprofessional Socialization and Valuing Scale (ISVS) was administered pre- and post-experience.

RESULTS

Paired t-tests of the ISVS total score and each subscale showed statistically significant increases over time. Multiple regression models indicated only the pretest score was a significant predictor of the posttest score for the total or subscale of the ISVS.

CONCLUSION

Social work programs that create interprofessional education and training opportunities can achieve positive outcomes in student attitudes toward interprofessional practice.

Where are social workers co-located with primary care physicians?

Social workers are increasingly working in primary care clinics that provide Integrated Behavioral Healthcare (IBH) in which a patient's physical, behavioral, and social determinants of health are addressed on a collaborative team. Co-location, where care is housed in the same physical space, is a key element of IBH. Yet, little is known about the rate of social workers co-located with primary care physicians (PCPs). To identify national rates of social worker co-location, data were drawn from the Centers for Medicare and Medicaid (CMS) National Plan and Provider Enumeration System (NPPES; n = 232,021 social workers, n = 380,690 PCPs). Practice addresses were geocoded and straight-line distances between practice locations of social workers and PCPs were calculated. More than 26% of social workers were co-located with a PCP. However, in rural settings only 21% were co-located (p < .001). Co-location also varied by PCP practice size, specialty, and state. This study serves as a benchmark of the growth of IBH and continued monitoring of co-location is needed to ensure social work workforce planning and training are aligned with changing models of care. Further, identifying mechanisms to support social work education, current providers, and health systems to increase IBH implementation is greatly needed.

The role of social work in the opioid epidemic: office-based opioid treatment programs

The opioid epidemic is a national emergency in the United States. To meet the needs of individuals diagnosed with Opioid Use Disorder (OUD) office-based opioid treatment programs (OBOT) are quickly expanding. However, social workers roles in OBOT programs are not clearly described. This paper will emphasize three roles social workers may fulfill in OBOT programs to combat the opioid crisis.

Social workers in integrated health care: Improving care throughout the life course

Great strides have been made in highlighting the strengths of the social work profession as a workforce vital to improving the health and well-being of individuals, families, and communities. Nevertheless, substantially more work is needed to advance education, practice, and research involving social workers' potential and their contributions to improved care throughout the life course. This special issue offers exemplars of the power of social work in integrated settings with the capacity to address the scope of behavioral health, psychosocial, and physical health care needs. In today's rapidly evolving heath care context, integrated care represents a promising direction for the future of health services, and may be leveraged to improve population health across the life course. Papers selected for this special issue focused on two themes: (a) defining the expanding roles and functions social workers fulfill in integrated health settings, and (b) identifying organizational and system factors that affect social workers' delivery of interventions in integrated health models. This special issue further articulates the added-value of social workers on health care teams and the resulting improved outcomes for patients, families, and communities. Through increased evidence, such as the knowledge gained from this special issue, it is our hope that the profession continues to advance the boundary-spanning roles and capabilities of social workers in integrated health settings-both in the hospital and in community-based settings.