Health in All Social Work Programs: Findings from a National Analysis of Social Work Education

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Background/Purpose:

Multiple drivers are forcing increased focus on health in social work; these include rampant health inequalities, demographic changes, and pervasive chronic diseases. In particular, implementation of the Affordable Care Act (ACA), with its “triple aim” of improved patient care, cost control, and population health has resulted in a changed health environment, complete with new opportunities and challenges (Zabora, 2013). With roughly half of social workers employed in health, a coherent cross-professional response is needed, including in training and education (Andrews & Browne, 2014). A considerable body of evidence has emerged demonstrating the effectiveness of prevention in diverse arenas, especially in working with youth populations in substance use and mental illness (Hawkins, Shapiro & Fagan, 2010).  No comprehensive current picture of social work education for health practice exists. This knowledge gap makes it difficult to engage in innovation for greater health impact. HIAPS’ goal is to provide the profession with a better understanding of health content at all levels of social work education and training.  

Methods:

A team of five researchers utilized content analysis, a method for rigorous analysis of content in communications, to evaluate all accredited U.S. BSW, MSW, and doctoral program websites for health content. The samples were developed from three organizations’ electronically-published lists: BSW/MSW (CSWE); doctoral (GADE) and CE (NASW).  Through iterative discussions and consultation of the literature, researchers arrived at codes for health, health-related, and wide-lens health (Bywaters & Napier, 2009; Crisp & Beddoe, 2013).

A total of 511 BSW, 245 MSW, 82 doctoral and 55 NASW program websites were analyzed for 1) health/ health-related coursework; and 2) health/health-related specializations and/or certificates. In the first round of coding, reviewers coded for health/ health-related content.  In the second, researchers sub-coded health content as “Wide-Lens” (broad public health framework) or “Narrow-Lens” (individually-oriented interventions framework). Inter-rater reliability was assessed by examination of rater coding for 10% of each sample.

Results: The data were aggregated and reported in frequencies. MSW program data is presented here, with some still under analysis.  With 222 MSW programs analyzed, 93% offered health courses. However, the majority (n=162; 73.1%) focused on clinical practice.  Only 38.5% (n=86) schools offered wide-lens courses. Some 57.2% of MSW programs offered health concentrations/specializations; 5.4% (n=12) were wide-lens, as defined by including more than one wide-lens course.

Discussion:

While the vast majority of MSW programs offer health content, the bulk are focused on clinical practice in health care; the infusion of prevention and other wide lens approaches—so vital to the profession’s impact on ACA, population health and health equity—is very limited.

These early results provide a beginning baseline for understanding the profession’s current approach to teaching about health. To thrive, it is essential that social work embrace the triple aim, and teach practitioners at every level how to practice in the new environment.  While clinical approaches remain centrally important in the ACA era, the need for wide-lens approaches is particularly critical, especially if social work is to impact health equity. Final analyses will provide a more comprehensive picture of social work education.