Health Care Reform: Implications for Social Work Practice, Research and Policy In Medical Settings

The Affordable Care Act (ACA) is set to profoundly alter the landscape of healthcare in the United States, bringing unprecedented changes in funding, delivery, and provision of services. Besides significantly increasing the overall number of insured Americans, ACA funding is slated to develop and expand the role of Community Health Centers (CHCs)as part of the greater “medical home” movement, emphasizing primary prevention and service integration over fragmented “safety net” medical care for the nation's vulnerable populations. These changes have the potential to considerably improve quality of care and reduce health disparities among vulnerable and underserved populations, including low-income, immigrant, disabled, mentally ill, and substance-abusing populations. On the crest of the changing face of the health care delivery system, social workers will need to reevaluate existing research and practice goals in order to ensure that enhanced access to treatment translates to high quality services and positive health and behavioral health outcomes for these populations. In this roundtable discussion, four social work researchers emphasizing practice and policy-based research will discuss how impending policy changes will alter distinct social work settings: CHCs serving low-income Latino immigrants, urban trauma centers, public emergency departments, and substance abuse treatment centers. CHCs are a main source of primary care for uninsured and publicly insured populations, including the nation's significant number of Latino immigrants, many of whom present with somatic symptoms of depression or other mental health problems, indicating a need for expanded integration of behavioral health care. Urban trauma centers and public emergency departments are also safety net providers, historically acting as the de facto “first line of defense” for uninsured or underinsured populations in the healthcare system. Current research on emergency department social work scope and practice could provide critical models for appropriate and efficient use of newly available medical and behavioral health services. Substance abuse treatment centers will likely also see significant rises in service usage, due to enhanced insurance coverage and greater parity between health and behavioral health benefits. Targeted and innovative research will be required to ensure that the vulnerable populations served in these settings, who stand to gain considerably from ACA related policy changes, receive the quality care required to reduce pervasive health and mental health disparities in the United States. In addition to practice implications, the methodological challenges of research in these settings will be highlighted. How can “on-the-ground” research in naturalistic settings translate to practice and, more broadly, large-scale policy change? How can agency, clinic, and client needs be emphasized in the policy implementation process? The goal for this roundtable will be to highlight the potential and challenges of the ACA, including a critical appraisal of social work research and its relationship to policy change and practice experience. Social work researchers and practitioners from all fields are invited to engage in discussion of how to best link policy, research, and practice in the face of significant policy reform in the nation's health care delivery system.