Shelley L. Craig, PhD, RSW
Assistant Professor
Raluca Bejan
MSW student
Barbara Muskat, PhD, RSW
Social Work Director, The
Hospital for Sick Children
MAKING THE
INVISIBLE
VISIBLE: Are
Medical Social
Workers
Addressing the
Social
Determinants of
Health?
Purpose
 This
study explores if health social workers
(HSWs) are addressing the vast range of
social determinants of health (SDH) within
their practice.
Social Determinants of Health
 It
is increasingly recognized that the social
determinants of health and the
associated health disparities cannot be
addressed without intervention in the
social circumstances of patients
(Schrecker, Chapman, Labonte, & De
Vogli, 2010).
 This is a role that, historically, has been
fulfilled by social workers in the health
care system.
Health Social Work
 Health
social workers (HSW) bring an
ecological perspective to health care, by
incorporating a full range of psychological
and emotional factors (Rachman, 1995) and
attention to how individuals interaction with
larger social systems influences their health
(Claiborne & Vandenburgh, 2001).
 HSW
work collaboratively as part of institutional
and community interprofessional teams to
support recovery, to promote quality of life in
the context of chronic illness and disability,
and to advocate for societal change to
address social disadvantages (Praglin, 2007).
The Changing Nature of Health
Social Work

Social workers delivering services in health
care face unique challenges and
opportunities in a rapidly changing
environment (Kim & Lee, 2009).

Almost 50% of all registered SWs in the
province of Ontario are employed in
medical settings
 We
talk about how we influence the SDH
but how?
Social Determinants of Health (SDH)

SDH have been defined as the cumulative
environmental factors shaping individuals’ health status

SDH are leveled along several axes of social
stratification




Socio-Economic Status (SES)
Social Supports
Diversity & Equity
Health Care Services
Social Determinants of Health (SDH)
SES
Income
& its Distribution
Unemployment
&
Employment Security
Education
Employment &
 Working Conditions
Early
Life
Social Determinants of Health (SDH)
SOCIAL SUPPORTS
Housing
Social
Food
Safety Net
Security
Social Determinants of Health (SDH)
DIVERSITY & EQUITY
Gender
Racism
Aboriginal
Disability
Social
Status
Status
Exclusion
Social Determinants of Health (SDH)
HEALTH CARE SERVICES
METHODS

Survey of SW professionals (n= 54) employed at
major hospitals across Toronto
Measures:




Basic demographic information (age, race,
gender identity, sexual orientation, educational
degree)
Job details (number of years in social work
practice, number of years in a health care setting,
job title)
Number and type of SDH addressed through
public health practice
Analyses:

SPSS 19.0: descriptive statistics, correlations and
chi-square analyses
SW Participants’ Demographic
Characteristics
Social Work Impact on SDH:
Frequencies and Correlations
Discussion



Social workers in health care are actively addressing the
social determinants of health in their daily practice
Specifically, SWs are addressing SES (Income Distribution
and Unemployment)and Social Supports (Housing and the
Social Safety Net)
 Statistically significant correlations were observed with
the variables of each SDOH construct (eg those actively
addressing Housing were also more likely to address the
Food Security and Social Safety Net determinants)
SDH related to Diversity and Equity, such as Racism,
Aboriginal Status, Gender and Social Exclusion, are not
addressed as frequently in daily practice

Statistically significant associations - SWs failing to
address one determinant might innately leave the
subsequent other unaddressed
Discussion
The focus on proximal/ tangible SDH may be related to:
1) The short term nature of patient contact in
health/hospital social work
2) The needs of the health care setting and the reason
social workers are hired
3) The importance of addressing the most pressing needs
first (food).
4) The limitations faced by HSW practicing in health care
systems to address complex determinants
This means that the presence of HSW is incredibly important
for the most vulnerable populations YET
Social workers expressed guilt that they werent addressing
the most complex determinants and seemed to brush over
the provision of tangible benefits.
Conclusions
 Social
work practice in health is now at
crossroads
 It needs to critically examine its ability to
establish a social justice framework and
apply a bio-psycho social perspective
within these settings.
 Future research should incorporate more
comprehensive measures of SDH and
investigate the ways in which client
outcomes are influenced by SW
interventions
References
Auerbach, C., Mason, S.E., & Heft-LaPorte, H. (2007). Evidence that supports the value of social work in hospitals. Social
Work in Health Care, 44(4), 17-32.
Auerbach, C. & Mason, S. (2010). The value of the presence of social work in Emergency Departments, Social Work in
Health Care, 49(4), 314-326.
Barbour, R. S. (2005). Making sense of focus groups. Medical Education, 39(7), 742-750. doi: 10.1111/j.13652929.2005.02200.x
Bronstein, L., Kovacs, P., & Vega, A. (2007). Goodness of fit. Social Work in Health Care, 45(2), 59-76.
Burg, M., Zebrack, B., Walsh, K., Maramaldi, P., Lim, J., Smolinski, K., et al. (2010). Barriers to accessing quality health
care for cancer patients: A survey of members of the Association of Oncology Social Work, Social Work in Health Care,
49(1), 38-52
Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks, CA:
Sage Publications.
Cohen, J.A. (2003). Managed care and the evolving role of the clinical social worker in mental health. Social Work, 48(1),
34–43.
Claiborne, N. & Vandenberg, V. (2001). Social workers role in disease management. Health and Social Work, 26(4), 217225.
Egan, M., & Kadushin, G. (2004). Job satisfaction of home health social workers in the environment of cost containment.
Health and Social Work, 29(4), 287–196.
References
Gibbons, J. & Plath, D. (2009). Single contacts with hospital social workers: The clients experiences. Social Work in Health Care,
48(8), 721-735.
Holliman, D.C., Dziegielewski, S.F., & Priyadarshi, D. (2001). Discharge planning and social work practice. Social Work in Health
Care, 32(3), 1–19. doi:10.1300/J010v32n03_01
Kasperski, J., Power, K., & VanderBent, S.D. (2005). Social work, primary care and Family Health Teams in Ontario: Delivering
comprehensive family-centered care. Joint paper by the Ontario College of Family Physicians (OCFP), the Ontario Association of
Social Workers (OASW) and the Ontario Home Care Association (OHCA).
Kim, H. & Lee, S. (2009). Supervisory communication, burnout, and turnover intention among social workers in health care
settings. Social Work in Health Care, 48(4), 364-385. doi: 10.1080/00981380802598499.
Lechman, C. & Duder, S. (2009). Hospital length of stay: Social work services as an important factor, Social Work in Health Care,
48(5), 495-504.
Mizrahi, T. & Berger, C. (2005). A longitudinal look at social work leadership in hospitals: The implications of a changing health
care system. Health and Social Work, 30(2), 155-165
Proctor, E.K. (2002). Social work research: Informing the frontlines and taking the long view. Social Work Research, 26(3), 130–
131.
QSR International (2006). NVivo7. OSR International Pty Ltd., www.qsrinternational.com
Richards, L. (1999). Data alive! The thinking behind NVivo. Qualitative Health Research, 9(3), 412-428.
Salvatore, E.P. (1988). Issues in collaboration and teamwork: A sociological perspective on the role definition of social work in
primary health care. Research in the Sociology of Health Care, 7, 199-239.
Thank You!
 Shelley

L. Craig, PhD, RSW
Shelley.craig@utoronto.ca