Working on the Interprofessional Team: Barriers and Facilitators to Social Worker Practice in Integrated Care Settings

Background and Purpose: Improving clinical and population health outcomes requires changes to the healthcare system that rely, in part, on a team-based approach. Interprofessional team-based models of care have been linked to improved patient outcomes and improved continuity of care, however the adoption of team-based care has been slow and challenges exist. Social work will continue as members of interprofessional teams in integrated settings as health care reforms continue to include new delivery models of care through integrated and preventative services. Social workers on integrated care teams collaborate with a variety of health professionals to address patient’s complex health and behavioral health needs. However, little information is available to understand the intricate teams social workers are a part of and their core functions. Further, even less is known about what individual and system level factors promote or inhibit social worker tasks and success as part of interprofessional teams. The aims of this study are to provide an enhanced description of social workers in interprofessional practice and to identify barriers and facilitators to social workers’ role as members of interprofessional teams in integrated settings.

Methods: An electronic survey was developed and administered to MSW students and field instructors at 62 Schools of Social Work who received HRSA funding in 2014 under the BHWET initiative to train and expand the behavioral health workforce (N=355). The survey was pre-piloted with a small sample (n=44) and cognitive interviewing was used to refine the instrument. The survey included sociodemographic information, role on the integrated treatment team, and barriers and facilitators of interprofessional practice. Data regarding the patient population was also collected, including the setting type (outpatient/inpatient), rural location, and components of integrated care. Descriptive, bivariate, and multivariate regression analyses were conducted to meet study aims.

Results: Of the 62 Schools of Social Work eligible, 60% responded including representation from all eight of HRSA/SAMHSA’s regions. Demographically, the majority were women, 75% identified as Caucasian, 10% identified as Black, 6.5% as Latino, and 8.5% as other or multiracial. Two-thirds of the sample were students and one third were field instructors. Social workers in integrated settings collaborate with other social workers but rely on a variety of health professions including nursing (69%), physicians (57%), psychiatrists (56%), psychologists (42%), pharmacists (30%), and physical therapists (17%).  Overall, respondents felt valued on their teams (80%).  However, data revealed a variety of barriers to task effectiveness that included individual, team, and organizational themes.

Conclusions and Implications: Increasing the uptake of interprofessional teams in integrated health care systems is a complex challenge that requires changes at the practice and educational levels in order to more closely align preparation for practice and healthcare reform. Continued development of interprofessional education is needed to promote new models of team based care for student learners and current practitioners. Health system administrators should be mindful of factors that impact interprofessional practice for social workers. Specific suggestions related to education, research, and practice to further increase social workers’ participation on interprofessional integrated healthcare teams are addressed.