Health Outcomes and Costs of Social Work Services: A Systematic Review.

BACKGROUND: Efforts to reduce expensive health service utilization, contain costs, improve health outcomes, and address the social determinants of health require research that demonstrates the economic value of health services in population health across a variety of settings. Social workers are an integral part of the US health care system, yet the specific contributions of social work to health and cost-containment outcomes are unknown. The social work profession's person-in-environment framework and unique skillset, particularly around addressing social determinants of health, hold promise for improving health and cost outcomes. OBJECTIVES: To systematically review international studies of the effect of social work-involved health services on health and economic outcomes. SEARCH METHODS: We searched 4 databases (PubMed, PsycINFO, CINAHL, Social Science Citation Index) by using "social work" AND "cost" and "health" for trials published from 1990 to 2017. SELECTION CRITERIA: Abstract review was followed by full-text review of all studies meeting inclusion criteria (social work services, physical health, and cost outcomes). DATA COLLECTION AND ANALYSIS: Of the 831 abstracts found, 51 (6.1%) met criteria. Full text review yielded 16 studies involving more than 16 000 participants, including pregnant and pediatric patients, vulnerable low-income adults, and geriatric patients. We examined study quality, health and utilization outcomes, and cost outcomes. MAIN RESULTS: Average study quality was fair. Studies of 7 social work-led services scored higher on quality ratings than 9 studies of social workers as team members. Most studies showed positive effects on health and service utilization; cost-savings were consistent across nearly all studies. CONCLUSIONS: Despite positive overall effects on outcomes, variability in study methods, health problems, and cost analyses render generalizations difficult. Controlled hypothesis-driven trials are needed to examine the health and cost effects of specific services delivered by social workers independently and through interprofessional team-based care. Public Health Implications. The economic and health benefits reported in these studies suggest that the broad health perspective taken by the social work profession for patient, personal, and environmental needs may be particularly valuable for achieving goals of cost containment, prevention, and population health. Novel approaches that move beyond cost savings to articulate the specific value-added of social work are much needed. As health service delivery focuses increasingly on interprofessional training, practice, and integrated care, more research testing the impact of social work prevention and intervention efforts on the health and well-being of vulnerable populations while also measuring societal costs and benefits is essential.

Social Work's Role in Medicaid Reform: A Qualitative Study.

OBJECTIVES: To critically analyze social work's role in Medicaid reform. METHODS: We conducted semistructured interviews with 46 stakeholders from 10 US states that use a range of Medicaid reform approaches. We identified participants using snowball and purposive sampling. We gathered data in 2016 and analyzed them using qualitative methods. RESULTS: Multiple themes emerged: (1) social work participates in Medicaid reform through clinical practice, including care coordination and case management; (2) there is a gap between social work's practice-level and systems-level involvement in Medicaid innovations; (3) factors hindering social work's involvement in systems-level practice include lack of visibility, insufficient clarity on social work's role and impact, and too few resources within professional organizations; and (4) social workers need more training in health transformation payment models and policy. CONCLUSIONS: Social workers have unique skills that are valuable to building health systems that promote population health and reduce health inequities. Although there is considerable opportunity for social work to increase its role in Medicaid reform, there is little social work involvement at the systems level.

Health in All Social Work Programs: Findings From a US National Analysis.

OBJECTIVES: To establish a baseline of health content in 4 domains of US social work education-baccalaureate, master's, doctoral, and continuing education programs-and to introduce the Social Work Health Impact Model, illustrating social work's multifaceted health services, from clinical to wide-lens population health approaches. METHODS: We analyzed US social work programs' Web site content to determine amount and types of health content in mission statements, courses, and specializations. Coding criterion determined if content was (1) health or health-related (HHR) and (2) had wide-lens health (WLH) emphasis. A second iteration categorized HHR and WLH courses into health topics. RESULTS: We reviewed 4831 courses. We found broad HHR content in baccalaureate, master's, and continuing education curricula; doctoral programs had limited health content. We identified minimal WLH content across all domains. Topical analysis indicated that more than 50% of courses concentrated on 3 areas: mental and behavioral health, abuse and violence, and substance use and addictions. CONCLUSIONS: As a core health profession, social work must strengthen its health and wide-lens content to better prepare graduates for integrated practice and collaboration in the changing health environment.

No Equity, No Triple Aim: Strategic Proposals to Advance Health Equity in a Volatile Policy Environment.

Health professionals, including social workers, community health workers, public health workers, and licensed health care providers, share common interests and responsibilities in promoting health equity and improving social determinants of health-the conditions in which people live, work, play, and learn. We summarize the underlying causes of health inequity and comparatively poor health outcomes in the United States. We describe barriers to realizing the hope embedded in the 2010 Patient Protection and Affordable Care Act, that moving away from fee-for-service payments will naturally drive care upstream as providers respond to greater financial risk by undertaking greater prevention efforts for the health of their patients. We assert that health equity should serve as the guiding framework for achieving the Triple Aim of health care reform and outline practical opportunities for improving care and promoting stronger efforts to address social determinants of health. These proposals include developing a dashboard of measures to assist providers committed to health equity and community-based prevention and to promote institutional accountability for addressing socioeconomic factors that influence health.

Mapping Dual-Degree Programs in Social Work and Public Health: Results From a National Survey.

Dramatic changes in the health system due to national health reform are raising important questions regarding the educational preparation of social workers for the new health arena. While dual-degree programs in public health and social work can be an important response to what is needed educationally, little is known about them. The National MSW/MPH Programs Study surveyed MSW/MPH program administrators to better understand the prevalence, models, structure, and challenges of these dual-degree programs. Forty-two programs were identified, and 97.6% of those contacted participated (n=41). Findings indicate that MSW/MPH programs are popular, increasing, geographically dispersed, and drawing talented students interested in trans-disciplinary public health social work practice. Challenges for these programs include the need for greater institutional support, particularly funding, and a general lack of best practices for MSW/MPH education. While findings from this study suggest graduates appear especially well-prepared for leadership and practice in the new health environment, additional research is needed to assess their particular contributions and career trajectories.

Adaptation of an HIV Medication Adherence Intervention for Adolescents and Young Adults.

Rising rates of human immunodeficiency virus (HIV) infection among adolescents and young adults underscore the importance of interventions for this population. While the morbidity and mortality of HIV has greatly decreased over the years, maintaining high rates of adherence is necessary to receive optimal medication effects. Few studies have developed interventions for adolescents and young adults and none have specifically been developed for sexual minority (lesbian, gay, and bisexual; LGB) youth. Guided by an evidence-based adult intervention and adolescent qualitative interviews, we developed a multicomponent, technology-enhanced, customizable adherence intervention for adolescents and young adults for use in a clinical setting. The two cases presented in this paper illustrate the use of the five-session positive strategies to enhance problem solving (Positive STEPS) intervention, based on cognitive-behavioral techniques and motivational interviewing. We present a perinatally infected heterosexual woman and a behaviorally infected gay man to demonstrate the unique challenges faced by these youth and showcase how the intervention can be customized. Future directions include varying the number of intervention sessions based on mode of HIV infection and incorporating booster sessions.