How Can We Better Measure Our Impact? Examining the Feasibility, Feasibility, Acceptability and Appropriateness of Integrating a Standardized Measure of Psychosocial Acuity into Social Work Documentation at One Large Pediatric Hospital

Background and Purpose: While social work (SW) has been identified as the core ‘social care’ workforce in health care settings (NASEM, 2019) SW Departments in health and hospital settings across the country have struggled to develop statistically compelling explanations of contributions to team-based care that demonstrate the overall value of SW to the health system, primarily due to the wide variety of patient-level outcomes targeted by SW intervention (Klett, 2014). Psychosocial acuity, defined as the severity of illness or patient condition that indicates the need for the subsequent intervention (Huber & Craig, 2007) may be a global metric that captures the breadth of modifiable targets affected by SW intervention in hospital-based and other health care settings. This study reports findings from a pilot trial undertaken in the preparation phase (Aarons, Hurlburt & Horwitz, 2014) of implementing the Psychosocial Acuity Scale (PAS; Klett et al., 2014), a reliable and valid instrument that assess seven domains of situational psychosocial acuity, as standard practice across all hospital settings and integrating the measure into the host hospital system’s existing electronic health record. While assessing the acceptability, feasibility and appropriateness of new assessment tools and documentation requirements among SW end-users is a critical step that can facilitate worker buy-in (Cresswell, 2013), it is a step frequently neglected when making EHR modifications and practice changes that require additional documentation.

Methods: Approximately 20% of a large urban pediatric hospital’s 200-person SW department was recruited to participate in the study. Using purposive sampling, participants were recruited across 5 unique setting types: inpatient, primary care, ambulatory/outpatient, primary care, emergency, and population-based specialty program settings providing care across inpatient and outpatient settings. Participants (n=42) were required to attend one of four 1.5 hour trainings in PAS scale administration and scoring. Each participant received a PAS manual and assigned a SuperUser who provided technical assistance for the duration of data collection. Participants recorded PAS ratings for each patient presenting to their care over 80 hours of consecutive shifts; upon completion, participants completed a posttest evaluation examining PAS implementation outcomes defined by Proctor et al (2013) of feasibility, acceptability and appropriateness using pragmatic, psychometrically sound instruments (Feasibility of Intervention Measure, [FIM], Acceptability of Intervention Measure [AIM], Intervention Appropriateness Measure [IAM], Weiner et al., 2017). Data collection occurred over a 4 month period (October 2019-January 2020) to minimize burden on 5 SUs.

Results: Of the 45 SWs recruited; N=2 attended the PAS training but did not participate in data collection; N=1 did not administer PAS appropriately and scores were excluded from the analysis. Overall the study yielded a 93.3% recruitment and retention rate. On average, results showed high levels of acceptability, feasibility, appropriateness, with 89.5%, 68.4%, and 57.9% of participating SWs agreeing or strongly agreeing on the FIM, IAM, and AIM, respectively.

Conclusions and Implications: SWs found the PAS to be feasible, acceptable and appropriate for use with pediatric populations. Integrating the PAS into standard documentation may be a viable way to articulate the value added of SW to the health care system.