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Integrated care, wherein the physical, behavioral, and social determinants of health (SDOH) are treated collaboratively on an interprofessional team, has emerged as an evidence-based model of care. As 60-80% of all primary care visits include a behavioral health component, increasing co-location rates of behavioral health and primary care providers (PCP) gives practitioners a greater ability to more comprehensively address patients’ healthcare needs. Integrated care can increase service utilization of behavioral health services, as it helps reduce barriers such as stigma, access, and accessibility. Social workers, the largest behavioral health provider workforce, are increasingly working in integrated models of heath care due to their training and skills related to screening assessment, behavioral health brief treatment, understanding of the SDOH, and their ability to collaborate with community agencies to meet client needs. Despite evidence indicating the increase of social workers in these settings, national estimates of the percentage of co-located social workers is unknown. To understand the rate of co-location of PCPs and social workers in integrated primary care, we conducted geo-spatial analysis using the CMS National Plan and Provider Enumeration System (NPPES) to report the rate of physical co-location between PCPs and social workers.
Methods:
This project analyzed the physical co-location of social workers to PCPs including physicians reporting specialties in Family Medicine, Internal Medicine, Pediatrics, Geriatrics, and OBGYN. As a comparison, colocation rates of psychologists to PCPs were also analyzed. Addresses were geocoded to latitude and longitude coordinates with the ESRI StreetMap database and ESRI ArcGIS software. The geocoding system provided information on the quality of each geocoding result and an algorithm for choosing the best address was applied. Straight-line distances between office locations of social workers (then separately for psychologists) and PCPs were measured and summarized. Distances smaller than ten meters were considered co-located while those further away were considered not co-located. Maps generated (and will be presented) show distribution as well as geographic, professional, and practice characteristics (i.e., rurality, medically underserved populations, and hospital system locations).
Results: The final dataset included 198,421 social workers, 360,631 PCPs, and 35,073 psychologists. Nationally, 29% of social workers were co-located with a PCP. However, in rural settings that number dropped to 26%. PCPs were significantly more likely to be collocated with social workers (34%) than with psychologists (23%). Rates of social work co-location varied by PCP type and will be presented. National maps helped identify areas of the US where the rates of co-location of social workers and PCPs vary, these maps will be used to illustrate the unequal distribution of the co-location of these professions.
Conclusions and Implications:
Findings support that social workers are increasingly working in primary care settings and 3 in 10 social workers in health care are co-located with a PCP. Training social workers to work in primary care settings is paramount to meet the needs of clients in integrated care. Co-location does not necessarily mean collaboration, but it increases the likelihood it can occur. Practice implication and future research will be discussed.