Social Work in Integrated Primary Care: A Systematic Review

Background and Purpose: The Affordable Care Act recognizes social work as having a key role in addressing behavioral health and, more broadly, the social determinants of health. Participating in team-based models of care, social workers are increasingly employed in integrated care settings where health teams coordinate treatment for behavioral and physical health conditions. Although social workers have worked in health care for more than 100 years, the scientific evidence to support emerging social work roles in integrated care settings is not clear. To address this gap, this paper reviews findings from a systematic review of randomized controlled trials in which social workers provided behavioral health and care management services in integrated primary care.

Methods: The systematic review focused on two research questions: (a) What roles do social workers fill in integrated primary care? (b) When social workers fulfill these roles, do patient outcomes improve over usual services? A comprehensive review protocol was adapted from the guidelines of the Cochrane Collaboration and PRISMA, then published on PROSPERO. The inclusion/exclusion criteria included peer-reviewed English-language journal articles (2000–2016), randomized design, social workers functioning as the intervention agent, interventions conducted in concert with a primary care provider, and quantitative reports of patient outcomes. Nine bibliographic databases were searched using search strings developed with a reference librarian. Additionally, forward and backward citation chaining was used to identify articles not identified in the formal search. Grey literature was searched through databases of dissertations, theses, and conference proceedings. Data were extracted by two raters who worked independently; disagreements were resolved through consensus and consultation with a third reviewer.

Results: After removing duplicates, 507 articles were identified for a title and abstract review, which yielded 179 articles selected for a full-text review. Of these, 16 studies met a priori criteria for inclusion in the analyses. In primary care settings, social workers filled two roles: behavioral health specialist and complex care manager. Findings suggest, as compared with routine services, providing behavioral health services through integrated primary care improves patient outcomes. An emerging social work role, complex care management involves coordinating health care for patients with complex or chronic needs and high potential for service use. Although social workers have long made patient referrals for community services, their involvement as full care managers for patients with chronic conditions or complex physical and social problems is a recent development.

Conclusions and Implications: While the complex care manager role has high symmetry with social work education, research on care management where social workers fulfill central coordinating roles is mixed and insufficiently developed. Research supports the provision of behavioral health care by social workers in integrated care settings. In this specialist role, social workers provide evidence-supported interventions for anxiety, depression, diabetes, obesity, pediatric behavior, and other problems. The research clearly suggests that these kinds of services, when provided by a social worker through integrated primary care, are effective.