Social Workers Roles in Integrated Primary Care: A Task Analysis of a Systematic Review of RCT Studies

Background and Purpose: New models of health care prioritize integrated services in which the physical, behavioral, and the social determinants of health are addressed in a single setting by an interprofessional team of providers that work collaboratively on a plan of care. Social workers(SW) are increasingly hired in being primary care settings to coordinate services, provide behavioral health assessment and treatment, and address psychosocial needs of clients. Although SWs have long worked in healthcare, evidence to support their emerging roles in integrated primary care settings is not clear. Further, an understanding of the tasks, roles, and functions of SW on these teams remains limited. To address this gap, this presentation reviews findings from a systematic review of randomized controlled trials in which SW were part of interprofessional teams in integrated primary care.

Methods: The systematic review focused on two aims: (1) identify the tasks, roles, and functions performed by SW in integrated settings; and (2) identify the effectiveness of these interventions. The review was limited to peer-reviewed studies, written in English, and published between 2000 and 2016. Nine databases were searched using terms developed in collaboration with a reference librarian and experts in the field. In total, 502 citations were retrieved. After the abstract screening, 107 were retained for a full-text review. Of these, 32 reports from 26 RCTs met inclusion criteria. Two independent researchers conducted the literature search, screened citations, and extracted data from the studies. Using the core competencies of integrated practice tasks, roles, and functions of SWs were extracted and coded from each study and synthesized by population, setting, and intervention type.

Results: In the 26 RCTs, social workers performed a variety of tasks. In more than 50% of the studies social workers facilitated communication among team members, provided patient education and psychoeducation, performed care management and assisted in medical provider consultation. Less than 50% of the interventions included a formal brief behavioral health treatment like problem solving therapy or cognitive behavioral therapy. From a review of the task analysis three primary functions of SWs were identified. First, as behavioral health specialists, SWs provided behavioral health treatment for mental health, substance use, and other behavioral health needs. Second, as care managers SWs coordinated the care of patients with chronic conditions, monitored care plans, assessed treatment progress, consulted with primary care physicians, and provided brief behavioral health interventions. Third, SWs acted in a referral role, linking patients to community resources when social determinants of health impacted treatment uptake and adherence. Most often SWs performed more than one of these functions at the same time.

Conclusions and Implications: Based on findings from the 26 studies included in the systematic review, the function of, and tasks used by SWs, show promise for improving the behavioral health and care of patients while reducing the use of higher cost health services. Although the future of healthcare reform is uncertain, interest in controlling costs, providing high-quality care, and improving patient and population health outcomes is unlikely to abate.