Professional competencies and training needs of professional social workers in integrated behavioral health in primary care
TL;DR: Results indicate that social workers feel prepared for general practice in IBH settings, but would benefit from additional training in IBh-specific competency areas identified in the survey, which can help guide social work training to improve workforce preparedness for practice inIBH settings in the wake of health care reform.
Abstract: The Affordable Care Act has led to a widespread movement to integrate behavioral health services into primary care settings. Integrated behavioral health (IBH) holds promise for treating mild to moderate psychiatric disorders in a manner that more fully addresses the biopsychosocial spectrum of needs of individuals and families in primary care, and for reducing disparities in accessing behavioral health care. For behavioral health practitioners, IBH requires a shift to a brief, outcome-driven, and team-based model of care. Despite the fact that social workers comprise the majority of behavioral health providers in IBH settings, little research has been done to assess the extent to which social workers are prepared for effective practice in fast-paced primary care. We conducted a survey of social workers (N = 84) in IBH settings to assess the following: (1) Key competency areas for social work practice in IBH settings and (2) Self-rated preparedness for effective practice in IBH settings. Online snowball sampling methods were used over a period of 1 month. Results indicate that social workers feel prepared for general practice in IBH settings, but would benefit from additional training in IBH-specific competency areas identified in the survey. Findings can help guide social work training to improve workforce preparedness for practice in IBH settings in the wake of health care reform.
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TL;DR: Ethical issues facing social workers in integrated health care settings, especially related to informed consent, privacy, confidentiality, boundaries, dual relationships, and conflicts of interest are identified and discussed.
Abstract: Integrated health care has come of age. What began modestly in the 1930s has evolved into a mature model of health care that is quickly becoming the standard of care. Social workers are now employed in a wide range of comprehensive integrated health care organizations. Some of these settings were designed as integrated health care delivery systems from their beginning. Others evolved over time, some incorporating behavioral health into existing primary care centers and others incorporating primary care into existing behavioral health agencies. In all of these contexts, social workers are encountering complex, sometimes unprecedented, ethical challenges. This article identifies and discusses ethical issues facing social workers in integrated health care settings, especially related to informed consent, privacy, confidentiality, boundaries, dual relationships, and conflicts of interest. The author includes practical resources that social workers can use to develop state-of-the-art ethics policies and protocols.
11 citations
TL;DR: Results showed that participants reported fair overall health, with mean scores on four of eight health indicators in the at-risk range, which is consistent with research on comorbidity that emphasizes the multidimensionality of health.
Abstract: Integrated primary and behavioral health care (PBHC) programs in community mental health (CMH) settings seek to address the health disparities and excess mortality of persons with serious mental illness (SMI) and comorbid medical disorders. The current cross-sectional, descriptive study utilized an integrated health data set to examine interrelationships among physical health, health-related, and psychosocial characteristics of 125 clients receiving integrated PBHC services in a CMH setting. Using baseline data collected by nurse care managers, researchers sought to develop a comprehensive, person-centered profile of adults in CMH agencies. Results showed that participants reported fair overall health, with mean scores on four of eight health indicators in the at-risk range. Disparities on some measures emerged for women, African Americans, and clients with a family history of cardiometabolic disorders. Participants reported moderate levels of functioning and psychological distress and moderately ...
10 citations
Cites background from "Professional competencies and train..."
...A handful of studies have assessed different aspects of interdisciplinary collaboration between social workers and health professionals (e.g., Horevitz & Manoleas, 2013; Lynch & Franke, 2013), but these later studies did not assess characteristics of service recipients....
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TL;DR: Analysis of a collaborative care intervention that targeted metabolically related health risk in adults diagnosed with SMI in a community mental health center found significant decreases in weight, cholesterol, and cigarette use.
Abstract: People living with serious mental illness (SMI) are at increased risk for metabolically related disease. This study aimed to examine the impact of a collaborative care intervention that targeted metabolically related health risk in adults diagnosed with SMI in a community mental health center. Markers of physical health were collected from a sample of 169 adults served by a federally funded integrated healthcare project. At the six-month follow-up, significant decreases in weight, cholesterol, and cigarette use were found. These findings highlight the important role social work practitioners hold for improving the health status of persons living with SMI.
10 citations
Cites background from "Professional competencies and train..."
...Social work practitioners are equipped for general practice in integrated care but are in need of additional training in the disease states integrated care often confronts (Horevitz & Manoleas, 2013)....
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TL;DR: In this sample with a preponderance of Medicare and Medicaid patients, social workers most often assisted patients with diabetes in obtaining medications or health insurance.
Abstract: Purpose: Social workers are positioned to address social determinants of health (SDHs), but their specific roles in outpatient primary care practice have not been well described. We aimed to describe needs of patients with diabetes addressed during social work (SW) consultations and their impact on disease control. Methods: This study was a retrospective review of electronic medical records of 977 patients with diabetes with a SW consultation at 3 primary care internal medicine sites in 2014. Diabetes and cardiovascular (CV) risk factor control were assessed before and after the SW encounter. Patient subgroups with uncontrolled diabetes or CV risk factors were compared with propensity-matched patients without a SW encounter. Of the 977 records, 300 were randomly selected for abstraction of needs addressed at the SW consultation using SDH categories established by Wilkinson and Marmot. Results: Patient insurance status included 52% Medicare and 32% Medicaid. The SDHs most often addressed were social gradient (67%; obtaining medications or health insurance) and social support (25%). Among our total population, there were no significant improvements in glycosylated hemoglobin (HbA1c), low-density lipoprotein (LDL) cholesterol, systolic blood pressure, or body mass index at least 3 months after the first SW consultation. For patients with uncontrolled diabetes (HbA1c >9% or LDL cholesterol >130 mg/dl), HbA1c improved by 1.5 versus 1.1% for matched controls (P = .03) and LDL improved by 37.7 versus 21.3 mg/dl for matched controls (P = .002). Conclusions: In this sample with a preponderance of Medicare and Medicaid patients, social workers most often assisted patients with diabetes in obtaining medications or health insurance. For patients with uncontrolled diabetes or cholesterol, a temporal association between SW consultation and improved disease control was noted.
10 citations
TL;DR: Findings from a study of 395 social workers who are members of interprofessional teams in integrated health care settings across the country are presented and recommendations for educational, practice, and policy efforts to better support integrated care, inter professional teams, and integration across health systems are offered.
Abstract: Roles for social workers on integrated health teams are growing, yet more information is needed to understand the workings of interprofessional teams and their practice settings. Even less is known about the barriers to practice social workers encounter or the system-level factors that promote or inhibit social workers’ success as members of interprofessional, integrated teams. This article presents findings from a study of 395 social workers who are members of interprofessional teams in integrated health care settings across the country. Discussion includes the characteristics, clinic types, and populations served are explored. Additionally, the discussion includes the common elements of team integration and clinic- or system-level barriers that affect social work practice in integrated, interprofessional settings. We offer recommendations for educational, practice, and policy efforts to better support integrated care, interprofessional teams, and integration across health systems.
9 citations
References
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TL;DR: The general view of descriptive research as a lower level form of inquiry has influenced researchers conducting qualitative research to claim methods they are really not using and not to claim the method they are using: namely, qualitative description.
Abstract: The general view of descriptive research as a lower level form of inquiry has influenced some researchers conducting qualitative research to claim methods they are really not using and not to claim the method they are using: namely, qualitative description. Qualitative descriptive studies have as their goal a comprehensive summary of events in the everyday terms of those events. Researchers conducting qualitative descriptive studies stay close to their data and to the surface of words and events. Qualitative descriptive designs typically are an eclectic but reasonable combination of sampling, and data collection, analysis, and re-presentation techniques. Qualitative descriptive study is the method of choice when straight descriptions of phenomena are desired.
9,029 citations
Additional excerpts
...Consistent with recommendations for descriptive qualitative research (Sandelowski, 2000) the authors then met to discuss themes and to ensure agreement on key themes in the respondents’ answers....
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TL;DR: Cultural humility is proposed as a more suitable goal in multicultural medical education that incorporates a lifelong commitment to self-evaluation and self-critique and to developing mutually beneficial and nonpaternalistic clinical and advocacy partnerships with communities on behalf of individuals and defined populations.
Abstract: Researchers and program developers in medical education presently face the challenge of implementing and evaluating curricula that teach medical students and house staff how to effectively and respect- fully deliver health care to the increasingly diverse populations of the United States. Inherent in this challenge is clearly defining educational and training outcomes consistent with this imperative. The traditional notion of competence in clinical training as a detached mastery of a theoretically finite body of knowledge may not be appropriate for this area of physician education. Cultural humility is proposed as a more suitable goal in multicultural medical education. Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and nonpaternalistic clinical and advocacy partner- ships with communities on behalf of individuals and defined populations.
2,277 citations
"Professional competencies and train..." refers background in this paper
...For example, Tervalon and Murray-Garcia (1998) describe the concept of “cultural humility,” which places the clinician in a fundamentally different juxtaposition with the patient....
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Book•
23 Nov 2011
TL;DR: This chapter discusses the design and development of the Survey Instrument, and the challenges faced in processing and Analyzing the Survey Data.
Abstract: Chapter 1 Introduction Chapter 2 Planning the Digital Survey Chapter 3 Sampling Chapter 4 Writing Survey Questions Chapter 5 Designing and Developing the Survey Instrument Chapter 6 Conducting the Survey Chapter 7 Processing and Analyzing the Survey Data Chapter 8 Reporting the Survey Results Chapter 9 Concluding Comments Appendix A: American Association for Public Opinion Research, Code of Ethics Appendix B: Commonly Used Survey Questions
1,059 citations
"Professional competencies and train..." refers background in this paper
...Because there is no database of IBH clinics (i.e., no known population) (Selm & Jankowski, 2006), links to the survey were sent out to IBH listservs and posted on professional message boards such as www.cfha.net, part of the Collaborative Family Health Care Association, a national professional…...
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TL;DR: A multifaceted primary care intervention improved adherence to antidepressant regimens and satisfaction with care in patients with major and minor depression.
Abstract: Background: This research study evaluates the effectiveness of a multifaceted intervention program to improve the management of depression in primary care. Methods: One hundred fifty-three primary care patients with current depression were entered into a randomized controlled trial. Intervention patients received a structured depression treatment program in the primary care setting that included both behavioral treatment to increase use of adaptive coping strategies and counseling to improve medication adherence. Control patients received "usual" care by their primary care physicians. Outcome measures included adherence to antidepressant medication, satisfaction with care of depression and with antidepressant treatment, and reduction of depressive symptoms over time. Results: At 4-month follow-up, significantly more intervention patients with major and minor depression than usual care patients adhered to antidepressant medication and rated the quality of care they received for depression as good to excellent. Intervention patients with major depression demonstrated a significantly greater decrease in depression severity over time compared with usual care patients on all 4 outcome analyses. Intervention patients with minor depression were found to have a significant decrease over time in depression severity on only 1 of 4 study outcome analyses compared with usual care patients. Conclusion: A multifaceted primary care intervention improved adherence to antidepressant regimens and satisfaction with care in patients with major and minor depression. The intervention consistently resulted in more favorable depression outcomes among patients with major depression, while outcome effects were ambiguous among patients with minor depression.
822 citations
"Professional competencies and train..." refers background in this paper
...The latter is consistent with several evidence-based interventions that emphasize manualized treatment and clinical algorithms (stepped care) for depression and anxiety such as the IMPACT trials and the CALM studies (Areán al., 2008; Ayalon, Areán, Linkins, Lynch, & Estes, 2007; Katon et al., 1996)....
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TL;DR: This methods review shows that most challenges are resolved when taking into account the principles that guide the conduct of conventional surveys.
Abstract: The World Wide Web (WWW) is increasingly being used as a tool and platform for survey research. Two types of electronic or online surveys available for data collection are the email and Web based survey, and they constitute the focus of this paper. We address a multitude of issues researchers should consider before and during the use of this method of data collection: advantages and liabilities with this form of survey research, sampling problems, questionnaire design considerations, suggestions in approaching potential respondents, response rates and aspects of data processing. Where relevant, the methodological issues involved are illustrated with examples from our own research practice. This methods review shows that most challenges are resolved when taking into account the principles that guide the conduct of conventional surveys.
758 citations