Prescription for health-care social work - labor unions.

Transformations in health care and attendant social work responses have eroded a health-care social work role grounded in holism and social justice. Tracing events at the intersection of social work, the labor movement, and health-care provision, this paper examines the evolution of social work's gravitation to micro-level practice and professionalism at the expense of macro practice, including labor organizing. It argues that engagement between health-care social work and labor unions is mutually beneficial and indispensable in preserving a role that reflects social work values in the face of massive socioeconomic inequality and health-care corporatization.

Implementation of health and mental health evidence-based practices in safety net settings.

Implementation of evidence-based practices (EBP) in health and mental health settings has not been as successful as anticipated. Patients in safety net settings have even less opportunity to receive evidence-based care. Translation research has been dominated by efficacy trials, which often do not translate to the complexity of safety net settings. Implementation research to date seems to focus mostly on provider and organizational contextual factors more than macro and patient factors crucial to outcomes in safety net settings. Focus on translation and adaptation of interventions to safety net settings, and use of qualitative methods to flesh out complex processes and involve more stakeholders will help give safety net patients access to state of the art care. This issue is important for social workers to understand due to their ethical obligation to advocate for social justice and access to care for vulnerable and oppressed populations.

Implementation of an evidence-based depression care management program (PEARLS): perspectives from staff and former clients.

INTRODUCTION: Although researchers develop evidence-based programs for public health practice, rates of adoption and implementation are often low. This qualitative study aimed to better understand implementation of the Program to Encourage Active, Rewarding Lives for Seniors (PEARLS), a depression care management program at a Seattle-King County area agency on aging. METHODS: We used stratified, purposive sampling in 2008 to identify 38 PEARLS clients and agency staff for participation. In 9 focus groups and 1 one-on-one interview, we asked participants to identify benefits and negative consequences of PEARLS, facilitators of and barriers to program implementation, and strategies for overcoming the barriers. Two independent researchers used thematic analysis to categorize data into key themes and subthemes. RESULTS: PEARLS benefits clients by decreasing depression symptoms and addressing other concerns, such as health problems. For staff, PEARLS provides "another set of eyes" and is a comprehensive program to help them meet clients' mental health needs. Barriers included issues with implementation process (eg, lack of communication) and the perception that eligibility criteria were more rigid than those of other agency programs. Recommended solutions included changing eligibility criteria, providing additional staff training, increasing communication, and clarifying referral procedures, roles, and responsibilities. CONCLUSION: Barriers to PEARLS delivery discourage referrals to what is generally viewed as a beneficial program. Implementing participants' strategies for overcoming these barriers can enhance delivery of PEARLS to a greater number of older adults and help them improve their depression symptoms.

Exploring barriers to primary care for patients with severe mental illness: frontline patient and provider accounts.

The goal of this study was to obtain in-depth descriptions of barriers to primary care for adults with serious mental illness (SMI) and to provide solutions to these barriers. Qualitative interviews were administered to mental health and medical providers, as well as patients. Several major themes were reported including: poor access to care; patient limitations (e.g., psychopathology, cognitive difficulties); societal, health care system, and provider bias; integrated/fragmented care, communication difficulties; and quality of care issues. Results point to a need for nursing professionals to continue to improve access to medical care for this population, as well as to continue to integrate mental health and primary care.

When high pressure, system constraints, and a social justice mission collide: A socio-structural analysis of emergency department social work services.

The emergency department (ED) can be a critical intervention point for many patients with multifaceted needs. Social workers have long been part of interdisciplinary ED teams. This study aimed to contribute to the limited understanding of social worker-patient interactions and factors influencing social work services in this setting. This paper reports a qualitative content analysis of social work medical record notes (N = 1509) of services provided to trauma patients in an urban, public, level 1 trauma center and an in-depth analysis of semi-structured interviews with ED social workers (N = 10). Eight major social work roles were identified: investigator, gatekeeper, resource broker, care coordinator, problem solver, crisis manager, advocate, discharge planner. Analyses revealed a complex interplay between ED social work services and multi-layered contexts. Using a social-ecological framework, we identified the interactions between micro or individual level factors, mezzo or local system level factors and macro environmental and systemic factors that play a role in ED interactions and patient services. Macro-level contextual influences were socio-structural forces including socioeconomic barriers to health, social hierarchies that reflected power differentials between providers and patients, and distrust or bias. Mezzo-level forces were limited resources, lack of healthcare system coordination, a challenging hierarchy within the medical model and the pressure to discharge patients quickly. Micro-level factors included characteristics of patients and social workers, complexity of patient stressors, empathic strain, lack of closure and compassion. All of these forces were at play in patient-social worker interactions and impacted service provision. Social workers were at times able to successfully navigate these forces, yet at other times these challenges were insurmountable. A conceptual model of ED social work and the influences on the patient-social worker interactions was developed to assist in guiding innovative research and practice models to improve services and outcomes in the complex, fast-paced ED.