1
|
Workforce Development in Integrated Care: A Scoping Review. Int J Integr Care 2021; 21:23. [PMID: 34899102 PMCID: PMC8622255 DOI: 10.5334/ijic.6004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/04/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Integrated care aims to improve access, quality and continuity of services for ageing populations and people experiencing chronic conditions. However, the health and social care workforce is ill equipped to address complex patient care needs due to working and training in silos. This paper describes the extent and nature of the evidence on workforce development in integrated care to inform future research, policy and practice. Methods A scoping review was conducted to map the key concepts and available evidence related to workforce development in integrated care. Results Sixty-two published studies were included. Essential skills and competencies included enhancing workforce understanding across the health and social care systems, developing a deeper relationship with and empowering patients and their carers, understanding community needs, patient-centeredness, health promotion, disease prevention, interprofessional training and teamwork and being a role model. The paper also identified training models and barriers/challenges to workforce development in integrated care. Discussion and Conclusion Good-quality research on workforce development in integrated care is scarce. The literature overwhelmingly recognises that integrated care training and workforce development is required, and emerging frameworks and competencies have been developed. More knowledge is needed to implement and evaluate these frameworks, including the broader health and social care workforces within a global context. Further research needs to focus on the most effective methods for implementing these competencies.
Collapse
|
2
|
Bowen DJ, Bao Y, Sirey JA, Ratzliff ADH. Integrated behavioral health treatments: innovations to achieve population impact. Transl Behav Med 2021; 10:520-526. [PMID: 32687181 PMCID: PMC8453803 DOI: 10.1093/tbm/ibaa059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Translational Behavioral Medicine is a journal that brings together relevant scholars and practitioners to produce articles of scientific and practical significance in a variety of fields. Here, we published a call for manuscripts detailing the study of innovations in the field of implementation of integrated care in the USA. We present 13 articles, all peer reviewed and all targeting some aspect of integrated care implementation. These articles include medical and community-based settings, as well as interventions that effectively engage peers, family members, and other social systems to support and extend care. The behavioral health conditions of interest include but were not limited to those that carry the greatest population disease burdens: depression, posttraumatic stress disorder, bipolar disorder, anxiety disorders, and substance abuse disorders. Examples of cross-cutting issues of high interest include research focused on provider and system barriers to integrated care implementation, interventions to improve the use of innovative treatments, disparities in access to care and quality of treatment, the intersection of behavioral health disorders and complex chronic conditions as it affects regimen adherence, health services organization and quality of care, policy effects, innovative methods using health information and mHealth technologies, and personalized/precision medicine. This introduction briefly summarizes some of the relevant topics and background literature. We close with an eye toward future research activities that will continue to advance the field and offer directions to stimulate new research questions in the area.
Collapse
Affiliation(s)
- Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle, WA, USA
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Jo Anne Sirey
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
| | - Anna D H Ratzliff
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| |
Collapse
|
3
|
Lombardi BM, Richman EL, Zerden LDS. Using Latent Class Analysis to Understand Social Worker Roles in Integrated Health Care. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2021; 18:454-468. [PMID: 33944704 DOI: 10.1080/26408066.2021.1914264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
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.
Collapse
Affiliation(s)
| | - Erica L Richman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Lisa de Saxe Zerden
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, USA
| |
Collapse
|
4
|
Siqueira M, Coube M, Millett C, Rocha R, Hone T. The impacts of health systems financing fragmentation in low- and middle-income countries: a systematic review protocol. Syst Rev 2021; 10:164. [PMID: 34078460 PMCID: PMC8170990 DOI: 10.1186/s13643-021-01714-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 05/19/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Health systems are often fragmented in low- and middle-income countries (LMICs). This can increase inefficiencies and restrict progress towards universal health coverage. The objective of the systematic review described in this protocol will be to evaluate and synthesize the evidence concerning the impacts of health systems financing fragmentation in LMICs. METHODS Literature searches will be conducted in multiple electronic databases, from their inception onwards, including MEDLINE, EMBASE, LILACS, CINAHL, Scopus, ScienceDirect, Scielo, Cochrane Library, EconLit, and JSTOR. Gray literature will be also targeted through searching OpenSIGLE, Google Scholar, and institutional websites (e.g., HMIC, The World Bank, WHO, PAHO, OECD). The search strings will include keywords related to LMICs, health system financing fragmentation, and health system goals. Experimental, quasi-experimental, and observational studies conducted in LMICs and examining health financing fragmentation across any relevant metric (e.g., the presence of different health funders/insurers, risk pooling mechanisms, eligibility categories, benefits packages, premiums) will be included. Studies will be eligible if they compare financing fragmentation in alternative settings or at least two-time points. The primary outcomes will be health system-related goals such as health outcomes (e.g., mortality, morbidity, patient-reported outcome measures) and indicators of access, services utilization, equity, and financial risk protection. Additional outcomes will include intermediate health system objectives (e.g., indicators of efficiency and quality). Two reviewers will independently screen all citations, abstract data, and full-text articles. Potential conflicts will be resolved through discussion and, when necessary, resolved by a third reviewer. The methodological quality (or risk of bias) of selected studies will be appraised using established checklists. Data extraction categories will include the studies' objective and design, the fragmentation measurement and domains, and health outcomes linked to the fragmentation. A narrative synthesis will be used to describe the results and characteristics of all included studies and to explore relationships and findings both within and between the studies. DISCUSSION Evidence on the impacts of health system fragmentation in LMICs is key for identifying evidence gaps and priority areas for intervention. This knowledge will be valuable to health system policymakers aiming to strengthen health systems in LMICs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020201467.
Collapse
Affiliation(s)
- Marina Siqueira
- Institute for Health Policy Studies, IEPS, Itapeva St 286, Conjunto 81-84, Bela Vista, São Paulo, SP, 01332-000, Brazil.
| | - Maíra Coube
- Institute for Health Policy Studies, IEPS, Itapeva St 286, Conjunto 81-84, Bela Vista, São Paulo, SP, 01332-000, Brazil
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BU, UK
| | - Rudi Rocha
- Institute for Health Policy Studies, IEPS, Itapeva St 286, Conjunto 81-84, Bela Vista, São Paulo, SP, 01332-000, Brazil
| | - Thomas Hone
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BU, UK
| |
Collapse
|
5
|
Courtnage T, Bates NE, Armstrong AA, Seitz MK, Weitzman TS, Fann JR. Enhancing integrated psychosocial oncology through leveraging the oncology social worker's role in collaborative care. Psychooncology 2020; 29:2084-2090. [DOI: 10.1002/pon.5582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/21/2020] [Accepted: 10/07/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Tiffany Courtnage
- Department of Psychosocial Oncology Seattle Cancer Care Alliance Seattle Washington USA
| | - Nicole E. Bates
- Department of Psychosocial Oncology Seattle Cancer Care Alliance Seattle Washington USA
- Department of Psychiatry and Behavioral Sciences University of Washington Seattle Washington USA
| | - Anne A. Armstrong
- Department of Psychosocial Oncology Seattle Cancer Care Alliance Seattle Washington USA
| | - M. Katherine Seitz
- Department of Psychosocial Oncology Seattle Cancer Care Alliance Seattle Washington USA
| | - Tammy S. Weitzman
- Department of Psychosocial Oncology Seattle Cancer Care Alliance Seattle Washington USA
| | - Jesse R. Fann
- Department of Psychosocial Oncology Seattle Cancer Care Alliance Seattle Washington USA
- Department of Psychiatry and Behavioral Sciences University of Washington Seattle Washington USA
| |
Collapse
|
6
|
Matthews EB, Bond L, Stanhope V. Understanding Health Talk in Behavioral Health Encounters: A Qualitative Analysis. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:551-563. [PMID: 32964333 DOI: 10.1007/s10488-020-01088-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 11/29/2022]
Abstract
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.
Collapse
Affiliation(s)
- Elizabeth B Matthews
- Graduate School of Social Service, Fordham University, 113 W 60th St, New York, NY, 10023, USA.
| | - Lynden Bond
- New York University Silver School of Social Work, 1 Washington Plaza, New York, NY, 10003, USA
| | - Victoria Stanhope
- New York University Silver School of Social Work, 1 Washington Plaza, New York, NY, 10003, USA
| |
Collapse
|
7
|
Abstract
Purpose
The purpose of this paper is to explore the outcomes identified by the evaluation of the national programme of integrated care pilots (ICPs) in England in the context of wider policies designed to deliver integrated care and to consider the challenges presented to policy makers and evaluators in distilling usable insights to promote effective policy.
Design/methodology/approach
This is a review of the ICP evaluation findings and the findings of a number of systematic reviews into aspects of integrated care. This paper shows the contextual analysis of these findings in relation to health policy in England.
Findings
The evaluation of ICPs in 2012 produced mixed results with some potentially useful findings for policy makers. However, numerous integrated care initiatives succeeded the ICPs suggesting that insights from evaluation are of limited usefulness to policy makers or are difficult to implement. A shift in macro policy within the English NHS may support integrated care by aligning objectives of clinical teams with those of the wider systems within which they operate.
Research limitations/implications
This review has not been based on a systematic review of the evidence on integrated care and reflects the personal experiences and views of the authors who have been active in this field of research for many years.
Originality/value
This paper considers why evaluation findings appear limited in their impact on policy in the field of integrated care. Views as to how evaluation might be undertaken so that it generates actionable insights are advanced.
Collapse
|
8
|
Hossain MS, Kiumarsi S, Yahya S, Hashemi S. The effect of healthcare management and physicians’ loyalty. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019. [DOI: 10.1080/20479700.2019.1620479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Md Shamim Hossain
- Graduate School of Business, Universiti Sains Malaysia, USM Penang, Malaysia
- Management Studies Department, Faculty of Business Studies, University of Rajshahi, Rajshahi, Bangladesh
| | - Shaian Kiumarsi
- Graduate School of Business, Universiti Sains Malaysia, USM Penang, Malaysia
| | - Sofri Yahya
- Graduate School of Business, Universiti Sains Malaysia, USM Penang, Malaysia
| | - Shiva Hashemi
- School of Housing, Building and Planning (HBP), (USM), Penang, Malaysia
| |
Collapse
|
9
|
González-Ramos G, Cohen EV, Luce V, González MJ. Clinical social work in the care of Parkinson's disease: role, functions, and opportunities in integrated health care. SOCIAL WORK IN HEALTH CARE 2019; 58:108-125. [PMID: 31307342 DOI: 10.1080/00981389.2018.1544600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/15/2018] [Accepted: 11/01/2018] [Indexed: 06/10/2023]
Abstract
Healthcare reform, including the focus on chronic illness, the growing role of neuroscience, the emphasis on collaborative interprofessional care, and more recently, on integrated medical and behavioral healthcare, have important implications for social work education and practice. Parkinson's disease, a chronic neurodegenerative illness exemplifying these trends, is an area in which social workers are increasingly involved. This paper provides (1) an overview of Parkinson's disease and its complexity, (2) a summary of role and functions identified in a survey of health social workers working with Parkinson's disease and/or neurology, and (3) education and practice recommendations for the social work profession.
Collapse
Affiliation(s)
| | - Elaine V Cohen
- a Silver School of Social Work , New York University , New York , USA
| | - Virge Luce
- a Silver School of Social Work , New York University , New York , USA
| | - Manny J González
- b School of Social Work, College for Design and Social Inquiry , Florida Atlantic University , Boca Raton , USA
| |
Collapse
|
10
|
Davis TS, Reno R, Guada J, Swenson S, Peck A, Saunders-Adams S, Haas-Gehres L. Social Worker Integrated Care Competencies Scale (SWICCS): Assessing social worker clinical competencies for health care settings. SOCIAL WORK IN HEALTH CARE 2019; 58:75-92. [PMID: 30457040 DOI: 10.1080/00981389.2018.1547346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 10/12/2018] [Accepted: 11/05/2018] [Indexed: 06/09/2023]
Abstract
Integrating physical and behavioral health services has the potential to reduce health disparities and service inequities among persons most at risk. However, clinical social workers in integrated health settings must possess relevant knowledge and skills to provide quality care to diverse populations. The Social Worker Integrated Care Competency Scale (SWICCS), developed to complement the Integrated and Culturally Relevant Care (ICRC) field education curriculum, measures students' self-perceptions of knowledge and skills associated with providing behavioral health care. Three student cohorts (n = 38) completed the SWICCS three times during an integrated care field practicum. Results indicated a statistically significant increase in student knowledge and skills at each time point, with a large effect size (r = -.87). The SWICCS demonstrated utility in measuring and tracking social work student acquisition of knowledge and skills required for practice in integrated care environments.
Collapse
Affiliation(s)
- Tamara S Davis
- a School of Social Work , Indiana University , Indianapolis , IN , US
| | - Rebecca Reno
- b School of Public Health , University of California, Berkeley , Berkeley , CA
| | - Joe Guada
- c College of Social Work , The Ohio State University , Columbus , OH
| | | | - Adriane Peck
- c College of Social Work , The Ohio State University , Columbus , OH
| | | | | |
Collapse
|
11
|
Black DR, Held ML, Wyatt TH. Developing a Computer Application to Prepare Social Workers for Integrated Health Care: Integrated Healthcare (Version 1.0). HEALTH & SOCIAL WORK 2018; 43:193-200. [PMID: 29901780 DOI: 10.1093/hsw/hly012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/25/2017] [Indexed: 06/08/2023]
Abstract
Integrated health care (IHC) is a proposed change to the U.S. health care system to address health care disparities for individuals with mental and physical health conditions. Computer applications may provide an effective strategy to prepare social workers for the transition to IHC. An Internet-based tool, Integrated Healthcare (Version 1.0) was developed and tested through rapid prototyping to access knowledge required for behavioral health providers to practice in IHC settings. Two focus groups (N = 5, N = 7) and individual interviews (N = 5) were conducted with social work professors and students. Nielsen's usability heuristics were used to evaluate data from focus groups and interviews, and changes were incorporated in development. The final computer application is an introduction to IHC concepts, reinforces the integrated nature of physical and behavioral health, and puts evidence-based knowledge at the point of care.
Collapse
Affiliation(s)
- Denise R Black
- Denise R. Black, PhD, LCSW, is part-time instructor, College of Social Work, University of Tennessee, 1618 Cumberland Avenue, 109 Henson Hall, Knoxville, TN; e-mail: . Mary L. Held, PhD, LCSW, is assistant professor, College of Social Work, University of Tennessee, Nashville. Tami H. Wyatt, PhD, RN, is Robert Wood Johnson Foundation executive nurse fellow, torchbearer professor in nursing, and associate dean of research, College of Nursing, University of Tennessee, Knoxville
| | - Mary L Held
- Denise R. Black, PhD, LCSW, is part-time instructor, College of Social Work, University of Tennessee, 1618 Cumberland Avenue, 109 Henson Hall, Knoxville, TN; e-mail: . Mary L. Held, PhD, LCSW, is assistant professor, College of Social Work, University of Tennessee, Nashville. Tami H. Wyatt, PhD, RN, is Robert Wood Johnson Foundation executive nurse fellow, torchbearer professor in nursing, and associate dean of research, College of Nursing, University of Tennessee, Knoxville
| | - Tami H Wyatt
- Denise R. Black, PhD, LCSW, is part-time instructor, College of Social Work, University of Tennessee, 1618 Cumberland Avenue, 109 Henson Hall, Knoxville, TN; e-mail: . Mary L. Held, PhD, LCSW, is assistant professor, College of Social Work, University of Tennessee, Nashville. Tami H. Wyatt, PhD, RN, is Robert Wood Johnson Foundation executive nurse fellow, torchbearer professor in nursing, and associate dean of research, College of Nursing, University of Tennessee, Knoxville
| |
Collapse
|
12
|
Briggs AM, Valentijn PP, Thiyagarajan JA, Araujo de Carvalho I. Elements of integrated care approaches for older people: a review of reviews. BMJ Open 2018; 8:e021194. [PMID: 29627819 PMCID: PMC5892746 DOI: 10.1136/bmjopen-2017-021194] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The World Health Organization (WHO) recently proposed an Integrated Care for Older People approach to guide health systems and services in better supporting functional ability of older people. A knowledge gap remains in the key elements of integrated care approaches used in health and social care delivery systems for older populations. The objective of this review was to identify and describe the key elements of integrated care models for elderly people reported in the literature. DESIGN Review of reviews using a systematic search method. METHODS A systematic search was performed in MEDLINE and the Cochrane database in June 2017. Reviews of interventions aimed at care integration at the clinical (micro), organisational/service (meso) or health system (macro) levels for people aged ≥60 years were included. Non-Cochrane reviews published before 2015 were excluded. Reviews were assessed for quality using the Assessment of Multiple Systematic Reviews (AMSTAR) 1 tool. RESULTS Fifteen reviews (11 systematic reviews, of which six were Cochrane reviews) were included, representing 219 primary studies. Three reviews (20%) included only randomised controlled trials (RCT), while 10 reviews (65%) included both RCTs and non-RCTs. The region where the largest number of primary studies originated was North America (n=89, 47.6%), followed by Europe (n=60, 32.1%) and Oceania (n=31, 16.6%). Eleven (73%) reviews focused on clinical 'micro' and organisational 'meso' care integration strategies. The most commonly reported elements of integrated care models were multidisciplinary teams, comprehensive assessment and case management. Nurses, physiotherapists, general practitioners and social workers were the most commonly reported service providers. Methodological quality was variable (AMSTAR scores: 1-11). Seven (47%) reviews were scored as high quality (AMSTAR score ≥8). CONCLUSION Evidence of elements of integrated care for older people focuses particularly on micro clinical care integration processes, while there is a relative lack of information regarding the meso organisational and macro system-level care integration strategies.
Collapse
Affiliation(s)
- Andrew M Briggs
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Pim P Valentijn
- Department of Patient and Care, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Integrated Care Evaluation, Essenburgh Research & Consultancy, Hierden, The Netherlands
| | | | | |
Collapse
|