There is growing recognition that social determinants have a significant impact on health which led to an increase in interventions integrating health and social services. Many of these integrated interventions have sought to address the unique needs of specific populations by tailoring their interventions appropriately. By focusing on certain populations, integrated interventions have the potential to reduce health disparities by addressing the structural drivers at work. To better understand the current body of integrated care literature, we systematically reviewed interventions published between 2010 and 2017 that addressed both health and social service needs in the United States in order to understand their impact on health and/or cost outcomes. Furthermore, we coded these studies based on their targeted population. The primary research questions guiding the review were as follows:
- Do interventions that integrate health and social services result in improved outcomes and reduced costs?
- What health concerns and populations are examined by integrated care interventions?
- What are common social service interventions that are used in integrated service interventions – both clinical and concrete?
While addressing these questions, we found that many studies focused on certain racial/ethnic groups, persons of low socioeconomic status, and/or sexual/gender minority groups. This review helps illuminate the overall scope of the integrated care literature to understand which groups have been focused on and which groups have been left out.
We conducted a systematic review consistent with PRISMA (Preferred Reporting Items for Systematic Review) and Campbell Collaboration guidelines. We searched three scholarly journal databases for articles reporting on randomized controlled trials in the United States between the years 2010 and 2017 that integrated health and social services. After removing duplicates and completing abstract and full text review, we were left with 137 articles. We first coded articles based on social service needs, health conditions, outcomes, and other demographic information. Studies were then coded to determine whether the interventions targeted persons based on the following identities: race/ethnicity, low-income or socioeconomically disadvantaged, and/or sexual/gender minority.
Of the studies in our review, 24.1% (33 studies) targeted persons of a specific race/ethnicity; 14.6% (20 studies) targeted persons who were low-income and/or socioeconomically disadvantaged; and 5.8% (8 studies) targeted persons of a sexual and/or gender minority group. Of these, 5% (7 studies) focused both on racial and economic background simultaneously. Of studies targeting gender/sexual minorities, 100% focused on HIV/AIDS as the health concern of interest whereas studies focusing on racial/ethnic identify focused on a variety of different health concerns.
These findings suggest that as the integration of health and social services becomes more common, it is important to elucidate which populations are being studied. By analyzing the recent body of literature on health and social service integration, we are able to determine which groups are currently being targeted by these interventions while also identifying where potential gaps in research exist. Additionally, we are able to identify the most common health concerns and social service needs experienced by specific populations in this body of literature.