Improving Mental and Physical Health Outcomes through a Collaborative Care Intervention

Background and Purpose: In the context of the COVID-19 pandemic, receiving consistent medical care to treat chronic health conditions such as diabetes and hypertension is more important than ever. Unfortunately, more than 47 million people in the U.S. are without health insurance making healthcare expensive and difficult to access. Minorities and those living in poverty are at greater risk of being uninsured. Similarly, early indications are that poverty, race, ethnicity, age, and underlying health conditions increase the risk of experiencing severe health complications and death from COVID-19.

Given the strong association between mental illness and chronic health conditions, the collaborative care model, nested within Federally Qualified Health Centers (FQHCs), represents a promising response to providing healthcare to the uninsured by integrating mental health services into traditional health services. The purpose of this presentation is to present findings from a mixed methods study addressing: 1) the impact of a collaborative care intervention on mental and physical health outcomes; 2) the specific interventions used by the social workers; and 3) the social workers’ perceptions of their roles and effectiveness.

Methods: The Mississippi Integrated Health and Disaster Program (MIHDP), affiliated with The University of Southern Mississippi School of Social Work, placed social workers in FQHCs to provide collaborative care to patients from 2013 – 2018. The FQHCs served many patients with chronic health conditions that were also in need of mental health services. Most individuals served did not have health insurance, had relatively low education rates, and earned below the median income.

A sample of 4,368 patient records was examined to measure the impact on mental and physical health. Anxiety and depression were measured using the GAD-7 and PHQ-9, while physical health was measured by the Summary of Diabetes Self Care Activities (SDSCA) scale. Data on social worker interventions with patients (N = 270) were collected using an intervention checklist that was developed by program staff. The checklist contained 70 social work intervention options and was completed by the social worker after each session. Qualitative data was captured through structured interviews with seven social workers.

Results: To determine impact of the intervention, two sets of analyses were run using the Friedman’s test and a series of t-tests. Significant improvements were shown in anxiety and depression for the overall sample. A subsample of 625 patients with diabetes indicated improvements in anxiety, depression, diet, glucose, exercise, and medication adherence. Descriptive findings from the intervention checklist revealed that the most common interventions were providing support (88.4%), encouraging patient (83.1%), evaluating for new events or circumstances (47.1%), problem solving (44.6%), and education for anxiety (40.2%). Using grounded theory, an analysis of the structured interviews indicated emerging themes around nuanced and non-traditional social work roles to promote the effectiveness of the care team.

Conclusion: As population health becomes more critical than ever, social workers are at the forefront of helping marginalized and underserved individuals. Information from this presentation can inform practitioners and researchers alike on effective interventions that improve mental and physical health outcomes.