A Thematic Analysis of Social Work Role Knowledge on Integrated Primary Care Teams

Background and Purpose: The Patient-centered medical home (PCMH) is a care model by which medical treatment is coordinated and managed by primary and further expands it by offering comprehensive care delivered by multiple disciplines in one setting. Social workers are becoming valued members of the PCMH, as they are uniquely suited to address the psychosocial needs that often complicate patient health. Current research shows that the roles of social workers are vastly misunderstood and their scope of practice is underestimated by other medical professionals.

Barriers to collaboration exist on the macro, mezzo, and micro levels and poor role knowledge can impede collaboration at each level. Research on interdisciplinary collaboration in medical settings has largely focused on hospitals and because scope of practice varies greatly due to population and setting, this research does not adequately translate to the PCMH model of care. The PCMH model is built on new procedures and frameworks that are quite different from the traditional medical model and requires more research focused on the particular barriers that challenge integrated primary care.  

Methods: Semi-structured interviews were used to explore the barriers and facilitators to collaboration and the knowledge of social work roles in the PCMH. Social workers and medical providers from integrated primary care practices were recruited from University of Texas Physicians in the greater Houston area. All ten of the social workers who participated were female, with an average age of 31. Four were African American, three were white, and three were Latinx. Of the fifteen medical providers interviewed, eleven were medical doctors and four were mid-level providers. Seven identified as white, four as Asian American, three as African American, and one as Latinx. Qualitative data was transcribed using QSR NVivo9 and thematic analysis was used to identify themes and subthemes.

Findings: Ten themes and sub-themes were identified. The topic of interdisciplinary care team roles yielded two themes: knowledge of social work roles and other professional roles, Knowledge of social work roles had three sub-themes: 1) education; 2) social work referrals; 3) value of social work. Other professional roles had one sub-theme: role boundaries. Facilitators and barriers generated two themes and one subtheme. Administrative leadership with a sub-theme of policy was identified as a barrier. Facilitators to collaboration identified one facilitator: co-location. Interpersonal relationships was identified as both a barrier and facilitator to collaboration.

Conclusion and Implications: The existing research regarding role knowledge and interdisciplinary collaboration has largely excluded social work, which is the focus of this research. This study also demonstrated the ability of social workers and medical providers to overcome role knowledge barriers and find meaningful ways to work together. The PCMH model of integrated care is rather new to the fields of primary care and interdisciplinary social work, and this creates new opportunities for social work programs to tailor education to create new clinical pathways that will help promote social work role knowledge and help advance and encourage organizational support for interprofessional social work.