THE SOCIAL WORK PROFESSION AS A
CATALYST OF CHANGE IN HEALTH CARE
Julie Miller-Cribbs, MSW, PHD
Professor & Director
Anne & Henry Zarrow School of
Social Work
University of Oklahoma
The problems are
serious, but we
can do better
Our physical and
mental health are
related
Trauma &
violence impact
mental and
physical health
Graphic from: http://www.thenationalcouncil.org/wp-content/uploads/2012/11/Childrens-Resilience-Initiative-9-1912.pdf
There is
tremendous
human and
economic cost
Oklahoma is particularly impacted
POLICY CHANGE &
IMPLEMENTATION
Federal Policy Influences Integrated
Care
Patient Protection and Affordable Care
Act (ACA): requires that behavioral care
(mental health and substance abuse
services) are included, investments in
community health centers and funding
for behavioral health staff, Medicaid
expansion
Mental Health Parity and Addiction
Equity Act of 2008 final rules – requires
that behavioral health services are
provided at same level as medical and
surgical care
expanded behavioral health services to 62.5
million Americans.
massive expansion of behavioral health
services
increased demand for mental/behavioral
health services in primary care and specialty
care
dramatic shifts in the delivery of mental health
services to primary care
Continued development & refinement of
short-term and effective interventions
Increased understanding of co-morbity,
biomarkers, stress and possible interventions
INTEGRATED CARE: WHY SOCIAL WORK?
• care for the most
vulnerable
• Reducing health
disparities
• Coordinated care
• Social justice
• Self-Determination
•
•
•
•
•
•
•
Education
& Training
Social
Work
Values &
Ethics
• Social work competencies
align with integrated care
competencies
Skills
Community engagement
Collaboration & teamwork
Advocacy
Systems & ecological focus
Resource mobilizers
Research & evaluation
Importance of a therapeutic
relationship
• Collaboration
• Communication skills
ALIGNED COMPETENCIES
IC COMPETENCIES
SW COMPETENCIES
1.
Identify as a professional social worker and conduct oneself
accordingly.
2.
Apply social work ethical principles to guide professional practice. 2. Collaboration & Teamwork
3.
Apply critical thinking to inform and communicate professional
judgments.
4.
Engage diversity and difference in practice.
5.
Advance human rights and social and economic justice.
6.
Engage in research-informed practice and practice-informed
research
7.
Apply knowledge of human behavior and the social environment.
8.
Engage in policy practice to advance social and economic wellbeing and to deliver effective social work services
9.
Respond to contexts that shape practice.
10. Engage, assess, intervene, and evaluate with individuals, families,
groups, organizations, and communities.
1. Interpersonal communication skills
3. Screening & Assessment
4. Care Planning & Care Coordination
5. Intervention
6.
Cultural Competency & Adaptation
7. Systems-oriented practice
8. Practice-based learning & Quality
Improvement
9. Informatics
EMBEDDED SOCIAL WORK
SERVICES
HISTORICAL ROLE OF SOCIAL WORK
IN HEALTHCARE
“It is an important part of the social worker’s
function to concern herself with the social problems
arising directly out of the nature of the medical
treatment.”
Harriet Bartlett
Dr. Richard Cabot, a senior physician at Mass General,
hired the first social worker in 1905 to provide social
work services in the outpatient clinics. In 1906, Dr.
Cabot met Ida Maude Cannon and hired her to jointly
organize the nation's first hospital-based social work
program. Of Cabot, Ida commented, "He was
presenting the idea of social service within the hospital
where sick patients, although separated from their
home and families, nevertheless cannot separate
themselves from their personal problems."/
Ms. Cannon and Dr. Cabot implemented systems to measure social work interventions, to
document these interventions in medical charts, to collaborate with medical professionals,
furthering the profession of medical social work. Their work promoted the expansion of the social
work role in the hospital and the inclusion of the social perspective as a regular part of the
medical treatment plan, for instance they began what we know today as "rounds". In a 1930
address Ms. Cannon stated, "The medical social service movement recognized that there should be
within the hospital, someone definitely assigned to represent the patient's point of view... And to
work out with the physician, an adaptation of the medical treatment in the light of the patient's
social condition". To realize this goal, interdisciplinary rounds with social workers were begun, and
continue to exists today.
20th
century public health
Dr. John Snow and his London
cholera epidemic map.
overcrowding
sanitation and hygiene
infectious diseases
From How the Other Half Lives by Jacob Riis.
21st century community health
Motor vehicle accidents
Environmental quality
Chronic disease
Obesity – poor nutrition, inactivity
Substance abuse: alcohol, drugs, tobacco
SOCIAL WORKERS AS ADVOCATES
THE NEED FOR ADVOCACY IN
HEALTH CARE
Both healthcare professionals and consumers must engage in advocacy to
increase the odds that consumers will receive (Jansson, 2011)
funding for care,
quality care based on acceptable guidelines,
protection of their ethical rights,
culturally competent services,
access to services in their community,
preventive services, and
attention to their mental health needs.
PATIENT ADVOCATES PROTECT AND
SUPPORT
Social work professionals are in a strategic position to become
leaders in promoting the role of patient advocate:
 by the nature of their values, their commitment to social justice
 their ability to effectively communicate and engage individuals
representing diverse backgrounds
 their application of the “person in environment” or psychosocial
perspective
PROMOTING
POLICY
CHANGE
SOCIAL WORKERS UNDERSTAND
SOCIAL DETERMINANTS OF HEALTH
I would argue this is one
of the strongest
contributions social
workers can make in
interdisciplinary teams,
this training makes them
uniquely suited to work
with vulnerable
populations who
experience a myriad of
conditions that influence
physical & mental health
GROWING APPRECIATION FOR
SOCIAL NEEDS
Transition from pathology
approaches, ‘medical
model’, to broader
approaches that address
principles of community
health, resiliency
MODEL SHIFT
Traditional or Interdisciplinary
Model
Community Science Model
One or a few disciplines involved, usually one
predominating
Multiple disciplines, with none predominating
Community members or agencies the
recipients of intervention
Community a full participant
Outcomes and measures set by research
agenda
Community involved in determining outcomes
& measures
Results disseminated to like-minded
professionals
Results distributed to communities for
improvement and replication
ACADEMIC DISCIPLINES IN COMMUNITY
MEDICINE
Health of Persons
Health of Communities
Life’s basic structures and functions:
molecules, cells, tissues, and
organisms, and environments
Collective structure and function
of human communities
The human community: policy,
influence, discourse, laws and
rules, culture & behavioral change
Methods of community health:
epidemiology, biostatistics,
measurement, system change
The human body in health and
disease
Methods of medicine: diagnosis,
treatment, continuing care, learning
and improvement
SOCIAL WORKERS ARE NATURAL
COLLABORATORS
Social workers understand relationships,
social competence, emotional intelligence
and are often relational leaders
RELATIONAL LEADERSHIP MIRRORS THE
SPIRIT OF CARE PRESCRIBED BY IHC
Provider &
Team
Patientprovider
Team &
Community
Partnership/Relationship
is central to care
Movement beyond traditional top
management leaders and compliance
of followers, the power structure is
inclusive
SOCIAL WORKERS CONTRIBUTE TO
HEALTH CARE TEAMS
Skills & Knowledge
 Medical Literacy
 Consultation Liaison skills
with medical problems
 Population Screening
 Chronic Disease Management
 Care Management Skills
 Educating medical staff about integrated care
 Evidence-Based Interventions
 Group Interventions
 Working within the fast-paced, action-oriented
ecology of primary care
Characteristics & Abilities
 Responsive
 Committed to social justice
 Commitment to the ethical practice of social work
 Commitment to social change
 Functional independently and collectively with
others
 Sensitive to relationships
 Interact positively and instructively with clients
SOCIAL WORKERS AS COMMUNITY
ENGAGEMENT SPECIALISTS
SOCIAL WORKERS AS SCIENTISTS
Integrated care
approaches: Emerging
Evidence & Best
Practices
SOCIAL WORKERS DO PREVENTION,
INTERVENTION AND CHANGE
SW training is competency based, with significant hours spent in practicum
Licensing ensures ethical practice and continuing education
Training in behavioral change (MI)
Training in cultural competence and adaption of models
Person-in-environment
Evidence based practice
Brief treatment models
 IC takes advantage of all of the inherent skills and competencies of
social work training and professional values & ethics
SOCIAL WORKERS AS PROMOTERS
OF ETHICAL PRACTICES
5 ethical issues of particular
importance to integrated health
 Informed consent
 Confidentiality
 Relationships with patients
 Relationships with colleagues
 Scope of practice
THE WAY FORWARD
THINKING BEYOND SILOS:
EDUCATION & PRACTICE
INTERPROFESSIONAL PRACTICE AND EDUCATION
Effective Inter-professional collaborative practice will require
Inter-professional education (IPE)
Integrated behavioral healthcare cannot move forward without a healthcare
work force that is trained in and embraces inter-professional collaboration
Our current healthcare system operates predominantly in professional silos
Education of healthcare professionals is also done in silos - few students
have an opportunity to work together and are not prepared to function as
part of a team in an integrated approach to care
ASPECTS OF SOCIAL WORK ARE
INCORPORATED INTO TRAINING OF OTHER
HC PROFESSIONS
A shift in attitude toward the relationship between physician and patientstressing collaboration, the importance of positive interactions, and the
role that all contributing parties serve in meeting the patient’s goals.
Interpersonal Communication
Process Vs. Outcomes
Systems Based Practice
IPE EXAMPLE: EPIC & SUMMER
INSTITUTE
http://www.ouhsc.edu/epic/Home.aspx
http://www.ou.edu/tulsa/community_medicine/2013.html
INTERPROFESSIONAL EDUCATION IMPLICATIONS
Intentional creation of interdisciplinary groups
Experiential elements facilitate co-learning, communication
practice
Professional meaning & world café: perspective taking
Teams, dialogue, relationship orientation
Experiencing community in teams, finding solutions as teams
Prototypes create opportunities for team work (compromise,
negotiation, project management, perspective taking)
Emphasis on collective learning, and appreciative inquiry
STUDENT PERCEPTIONS OF THE LEARNING ENVIRONMENT: SI
Learning Culture – Important Elements
 Relationships
 Socialization
 Experiential activities
Community Health Principles
 Awareness of Underserved
 Transdisciplinary Work
 Problems and Solutions
 Appreciation of Other Profession
Key learning for participants, from analysis of multiple years
of qualitative data
Products of learning: reflection, change & inspiration
 Self-Reflection
 Broaden Perspective
Sometimes re: people in poverty (most common) but sometimes re:
 Inspiration/Motivation
working with or understanding OTHER professions
 Commitment
 Attitudinal Shift
INTERDISCIPLINARY PARTNERSHIPS
SI participants learn to appreciate other disciplines and value experiences and opportunities for
interdisciplinary collaboration and teamwork
Data also revealed important lessons related to communication  the SI experience allowed for
interdisciplinary conflict resolution related to professional bias to occur
“I learned how other professions play important roles in the process of giving care to people in the community.”
"I have learned that other professions need to better communicate with each other in order to help the community as a whole.
Egos need to be left aside, and people need to focus on the "bigger picture," which is healthcare for all in the community."
"The impact they have on our community. I learned what their roles are in clinics and how we each depend on the other to make
the process work best for patients. Communication is key."
EPIC DATA: STUDENT FEEDBACK
It is difficult to get people with different backgrounds to work together
I need to learn when to speak up
Importance of communication
Importance of listening
Everyone in the group has important, valuable knowledge to contribute. Listening is
very important to make sure details are heard.
Process of students communicating with each other. How certain professions always
gave debriefing, might be interesting to see other disciplines giving overview of
concerns
Giving and receiving feedback
Learning the dynamics between disciplines
How to work with various professions
I learned that different disciplines overlap but can easily work together
Learning to let go of stereotypes
Social work is very, very helpful!
DEVELOPING INTERDISCIPLINARY CORE COMPETENCIES
AN INTRODUCTION TO THE IMPORTANCE OF
INTERPROFESSIONAL WORK
How do you communicate with other professions in a interprofessional setting?
How to account for multiple perspectives in understanding a problem, finding a solution?
How do we move to a community model?
How de we engage communities in our discussion of problems and solutions?
SOCIAL WORK OPPORTUNITIES



Social workers practice
 Developing models, providing expertise in IC teams
 Lending expertise in community work & engagement
 Lending expertise in bio-psycho-social model and relevance to health of individuals and
communities
 Advocacy on all levels (patient, policy, AND for the PROFESSION)
Social work education
 Student practicum – engaging with whole communities and across disciplines in primary care
settings
 Collaborative work across disciplines to create innovative curriculum, common competencies
in community health & integrated care
 Focus on relationship of physical/mental health in coursework
Social work research
 Science of community wellness, lending expertise in community based participatory and action
research
RESOURCES & REFERENCES
Council on Social Work Education, Social Work and Integrated
Behavioral Health Project
http://www.cswe.org/CentersInitiatives/DataStatistics/IntegratedCare.a
spx
Core Competencies for Integrated Behavioral Health and Primary Care
http://www.integration.samhsa.gov/
The place of social work in public health – 1996
http://www.socialwelfarehistory.com/programs/the-place-of-social-work-in-public-health/