THE SOCIAL WORK PROFESSION AS A CATALYST OF CHANGE IN HEALTH CARE Julie Miller-Cribbs, MSW, PHD...
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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
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
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The problems are serious, but we can do better
Slide 3
Our physical and mental health are related
Slide 4
Trauma & violence impact mental and physical health
POLICY CHANGE & IMPLEMENTATION 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 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 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
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INTEGRATED CARE: WHY SOCIAL WORK? Education & Training
Values & Ethics Social Work Skills Social work competencies
align with integrated care competencies care for the most
vulnerable Reducing health disparities Coordinated care Social
justice Self-Determination Community engagement Collaboration &
teamwork Advocacy Systems & ecological focus Resource
mobilizers Research & evaluation Importance of a therapeutic
relationship Collaboration Communication skills
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ALIGNED COMPETENCIES SW COMPETENCIES 1.Identify as a
professional social worker and conduct oneself accordingly. 2.Apply
social work ethical principles to guide professional practice.
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 well-being 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. IC
COMPETENCIES 1.Interpersonal communication skills 2.Collaboration
& Teamwork 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
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EMBEDDED SOCIAL WORK SERVICES
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HISTORICAL ROLE OF SOCIAL WORK IN HEALTHCARE It is an important
part of the social workers function to concern herself with the
social problems arising directly out of the nature of the medical
treatment. Harriet Bartlett
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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. 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." / /
Slide 14
20 th century public health overcrowding sanitation and hygiene
infectious diseases From How the Other Half Lives by Jacob Riis.
Dr. John Snow and his London cholera epidemic map.
Slide 15
21 st century community health Motor vehicle accidents
Environmental quality Chronic disease Obesity poor nutrition,
inactivity Substance abuse: alcohol, drugs, tobacco
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SOCIAL WORKERS AS ADVOCATES
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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.
Slide 18
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
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PROMOTI NG POLICY CHANGE
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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
Slide 23
GROWING APPRECIATION FOR SOCIAL NEEDS Transition from pathology
approaches, medical model, to broader approaches that address
principles of community health, resiliency
Slide 24
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
Slide 25
ACADEMIC DISCIPLINES IN COMMUNITY MEDICINE Health of Persons
Lifes basic structures and functions: molecules, cells, tissues,
and organisms, and environments The human body in health and
disease Methods of medicine: diagnosis, treatment, continuing care,
learning and improvement Health of Communities 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
Slide 26
SOCIAL WORKERS ARE NATURAL COLLABORATORS Social workers
understand relationships, social competence, emotional intelligence
and are often relational leaders
Slide 27
RELATIONAL LEADERSHIP MIRRORS THE SPIRIT OF CARE PRESCRIBED BY
IHC Movement beyond traditional top management leaders and
compliance of followers, the power structure is inclusive
Partnership/Relationship is central to care Patient- provider
Provider & Team Team & Community
Slide 28
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
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SOCIAL WORKERS AS COMMUNITY ENGAGEMENT SPECIALISTS
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SOCIAL WORKERS AS SCIENTISTS
Slide 31
Integrated care approaches: Emerging Evidence & Best
Practices
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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
Slide 33
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
Slide 34
THE WAY FORWARD
Slide 35
THINKING BEYOND SILOS: EDUCATION & PRACTICE
Slide 36
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
Slide 37
ASPECTS OF SOCIAL WORK ARE INCORPORATED INTO TRAINING OF OTHER
HC PROFESSIONS A shift in attitude toward the relationship between
physician and patient- stressing collaboration, the importance of
positive interactions, and the role that all contributing parties
serve in meeting the patients goals. Interpersonal Communication
Process Vs. Outcomes Systems Based Practice
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IPE EXAMPLE: EPIC & SUMMER INSTITUTE
http://www.ouhsc.edu/epic/Home.aspx
http://www.ou.edu/tulsa/community_medicine/2013.html
Slide 39
INTERPROFESSIONAL EDUCATION IMPLICATIONS Intentional creation
of interdisciplinary groups Experiential elements facilitate
co-learning, communication practice Professional meaning &
world caf: 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
Slide 40
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 Products of learning: reflection, change &
inspiration Self-Reflection Broaden Perspective
Inspiration/Motivation Commitment Attitudinal Shift Key learning
for participants, from analysis of multiple years of qualitative
data Sometimes re: people in poverty (most common) but sometimes
re: working with or understanding OTHER professions
Slide 41
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."
Slide 42
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!
Slide 43
DEVELOPING INTERDISCIPLINARY CORE COMPETENCIES
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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?
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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
Slide 46
RESOURCES & REFERENCES Council on Social Work Education,
Social Work and Integrated Behavioral Health Project
http://www.cswe.org/CentersInitiatives/DataStatistics/IntegratedC
are.aspx
http://www.cswe.org/CentersInitiatives/DataStatistics/IntegratedC
are.aspx Core Competencies for Integrated Behavioral Health and
Primary Care
http://www.integration.samhsa.gov/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/