Towards a Better Understanding of Social Work Roles in Integrated Health Settings: A Latent Class Approach

Background and purpose: Social work (SW) is an emerging workforce in integrated health settings and is deployed across health sectors to address complex client needs, including behavioral health and the social determinants of health. Although SWs are increasingly working in these settings, the roles, functions and scope of practice of SWs are not well defined. Research on SWs role on integrated care teams suggests that they fulfill multiple functions and that their roles vary by setting and patient population. In order to better identify the varying roles and functions SWs may fulfill on inter-professional health teams, we used latent class analysis (LCA) to better develop typologies or profiles of SW functions and defining characteristics. LCA helps elucidate if there are distinct groups of SWs using certain skills and if there is function overlap between groups. In order to seek clarity around social work roles in integrated health care settings, the following questions guided the analysis: (1) Are there meaningful classes of SW roles and functions in integrated health settings? (2) What characterizes and predicts the classes of SW roles and functions?

Methods: An electronic survey was developed, piloted, and administered to a sample of Health Resource Service Administration (HRSA) funded SW students and their supervisors (N=395). The survey focused on understanding roles of SW in integrated settings and asked how often respondents engaged in 25 activities and interventions. Patient population, setting, and elements of team integration were collected. A LCA was conducted to estimate latent sub-groups of respondents who reported similar weekly use of activities/interventions. Class enumeration was selected using pre-specified fit criteria demonstrating best model fit.

Results: Respondents reported using an average of 14.6 (SD=4.7) distinct tasks/interventions at least weekly. Most worked in hospital systems (55%), with vulnerable patients including those with mental health needs (75%) and psychosocial stressors (76%). SW in hospital systems and those in co-located settings used significantly more tasks than those in community settings (16.6 vs. 13.8, p<.01). Five classes of SW functions were identified and varied significantly by patent population and setting. Class one and two focused almost exclusively on providing behavioral health interventions, yet class one also concentrated heavily on medication management and interactions with the inter-professional team. Class three and four focused mainly on care management but differed slightly. One focused on patient navigation and was not likely to interact with the care team whereas the other had stronger patient relational components, regularly utilized psychosocial assessments, patient education, and motivational interviewing. Class five was the most flexible, providing both behavioral health interventions and assessments, as well as care management and service referrals.

Implications: Findings indicate there are distinct classes of SW roles and functions, that at times overlap. Because SW’s roles and functions significantly vary by group, it is necessary to consider how education, regulatory, and reimbursement needs also vary by these distinct groups of SWs. Policy recommendations related to SW scope of practice, licensure, and reimbursement will be addressed.