“Thinking about how the U.S. health care system should address social determinants of health raises many important questions,” he said. Rachel Warner, MD, PhD, spoke during the opening of LDI’s “Addressing Societal Needs to Improve Health” virtual seminar on March 5. “Perhaps the biggest question is who is responsible for doing so: the health care sector? the social services sector? another stakeholder, or a combination thereof?”
Werner, executive director of LDI and moderator of an event that brought together three top experts involved in the integration of social services into physical health care, got into the nitty-gritty of one of the field’s biggest challenges. .
The three panelists are– Jorge DelvaPhD, MSW, Dean of the Boston University School of Social Work and Director of the Center for Innovation in Social Work and Health. caroline fichtenbergPh.D., Managing Director, Social Intervention Research and Evaluation Network (SIREN), University of California, San Francisco.and Kathleen NoonanJD, CEO of the Camden Health Care Provider Federation, believes that inadequate nutrition, housing, transportation and other social determinants are key drivers of poor health and premature death in marginalized communities. Agreed to be one. But how can we change that?
Some community advocates say hospitals and health systems should expand patient services to include social services that can address these needs. Additionally, some large healthcare organizations, including UnitedHealth Group, Humana, and Kaiser, are experimenting with social care integration programs that connect patients with social workers and social support resources.
social worker
Social work is an academic discipline focused on helping individuals and communities meet their basic daily needs and achieve long-term well-being. Social workers serve as advisors, information agents, and navigators with advanced knowledge of the resources available through public health, public assistance, and other programs available to people living in under-resourced settings. Masu.
In theory, the best integrated health and social care focused on social determinants is a close collaborative partnership. While doctors and nurses focus on a patient’s immediate medical condition, social workers also address issues such as food insecurity, inadequate housing, homelessness, unemployment, lack of transportation, and other issues that directly contribute to ongoing health problems. We are evaluating the factors. Social workers identify ways to connect patients to resources that can solve or alleviate problems in those areas and maintain contact over time to monitor the progress of the situation. Health care provider clinicians and social workers work together to treat the whole patient based on that patient’s lived experience, rather than simply providing care in a short clinical setting with little information.
There are 650,000 social workers nationwide, and about half of them work in some type of medical facility. However, panelists noted that there is wide variation in how and to what extent integration of social and health services is actually achieved in these settings. Additionally, there is wide variation in the amount of research evidence available regarding the overall integration process and its individual components.
latest evidence
“One of the most common things these programs do is screen for social needs in a clinical setting,” said panelist Fichtenberg, a research fellow in the UCSF Department of Family and Community Medicine. Ta. “This is one of the first ways to bring information about that part of a patient’s life into the clinical setting. It’s also one of the areas where we’ve done the most research. We found that patients were quite receptive to being asked about social risks in a clinical setting, as long as it was done in a focused and non-stereotypical manner.”
“Another area of activity being studied is the process of referring or directing patients to internal or external social services,” Fichtenberg said. “A growing body of evidence shows that it is possible to connect people to services, but questions have arisen about who should do it and what is the best way to do it. One component that has received a lot of interest recently is off-the-shelf technology that allows personnel to search for relevant services and refer patients to those services electronically. This is becoming very popular. But there’s not much evidence about how effective it is.”
“And the services that are needed are actually provided by third-party services that the health system can use,” Fichtenberg continued. “This includes things like food pantries, medically tailored meals, home-delivered meals, and medical and legal partnerships. There is really good evidence emerging of the benefits of these. Housing is also an important area. The housing evidence is very complex and still growing.”
“The current challenge for the human services sector in all of this is that a lot of the work is driven primarily by health priorities, rather than a mix of health and human services priorities,” Fichtenberg said. . “It may have something to do with misaligned incentives. For example, the medical side is focused on high-rate users and less focused on children. But social factors It’s very important throughout the lifespan. Ensuring that children have an environment where they can grow and develop properly is very important for their long-term health.”
Inappropriate governance rules
Founded in 2006 to provide an integrated system of medical and social services to millions of healthcare superusers, the Camden Coalition of Healthcare Providers employs a care team of certified nurses, social workers, and community health workers. We are hiring. As part of its goal to coordinate regional services for patient committees in 2015, the company created ‘Aunt Bertha’. It is an easily searchable online digital tool that indexes social service assistance programs such as food, housing, transportation, medical, financial, and legal services. , education and employment resources.
“We’re very focused on connecting medical and non-medical providers, and we’ve been doing that for a long time,” said Noonan, who is also an LDI adjunct senior fellow. “This is very difficult and I’m not surprised that we haven’t found any evidence yet.”
“Some of the biggest challenges for us are the fragmentation of the whole system and the lack of governance rules about who is in charge,” Noonan said. It becomes very difficult when you have federal rules, state rules, and local rules and you don’t know who can tell whom to do what. That’s something we need to work on more. ”
“Another issue for us is the lack of permanent support for some patients,” she continued. The system likes programs that start and end repeatedly, but some people always need help. But we don’t really want to work on that because it goes against our idea that once the system fixes people, that’s it. However, our Housing First program is a much lighter touch intervention, although she does check in with people at least once a month. They have graduated from our program and we make sure everything is on track. Some people need a constant light touch. ”
“The third issue is investing in primary care,” Noonan said. “When the ACA was passed, we got blinded by the things we thought were going to happen in primary care after that. But those didn’t really happen. The integration into primary care didn’t happen. And while we’re talking about social determinants and health care systems like food and transportation, we’re not investing in behavioral health and the areas that we think are closest to health care systems. I think the conversation around that is really missing. I’m more interested in it than food and housing.”
Social workers’ struggle for integration
When asked how close the sector was to a true health and social care partnership, panellist Delva said: “Social workers have a vital role to play in addressing the social determinants of health. Despite the medical community’s recent discoveries that there are a number of individuals involved, their role remains poorly understood.” Some say they’ve been working in facilities for 20 years, but colleagues in other professions still puzzle over what exactly social workers do. ”
“While health care institutions still operate in a manner that emphasizes social worker services, we are far from integration into a profit-driven system due to the inability to remunerate them within existing reimbursement mechanisms. And concerns about the social determinants of health are still new and not central to the mission of health care systems. In some places, it is even perceived as a deviation from the original mission. Masu.”
“Too often, social work is used as a cost center rather than a necessary part of the care to ensure equitable and optimal health outcomes. Yes, the potential of social workers is now clear. However, we are not the most empowered people in the settings where we work. Social workers are often not placed in such a way that each patient has access to a social worker.”
“In many settings where social workers are deployed, social workers recognize that the systems in place have historically, intentionally, and systematically enacted policies and programs that disenfranchise certain communities. Social workers play a truly important role by bringing perspectives to the table that remind us that social workers can help remove stigma and open people’s hearts to the humanity of the people we work with. We will support you.”
“Finally, I am hopeful for the future. The questions we are discussing here today are extremely important, but they reflect an attempt to put a band-aid on a fragmented health care system.” Delva said. “When I hear about the health care system providing important things to help meet needs, such as housing, legal care, and food reserves, I still wonder, ‘Why doesn’t society provide those things?’ Why are our hospitals overburdened? The bottom line is, why do we as a society must muster the political will and imagination to ensure that people go hungry, are homeless, don’t have access to quality education, and don’t have universal health care? Why can’t we pursue policies and programs that prevent people from being left out?”