Patient Interactions with Dental School Clinic's Social Work Services: A Coding Taxonomy

Background and Purpose: The social work model of care within dental school clinics was established as an approach to address the biopsychosocial barriers that prevent patients from receiving quality and consistent oral health care. In 2015, Columbia University College of Dental Medicine (CDM) saw the need to incorporate a social work lens to aid in dental students’ understanding of psychosocial factors which impact a patient’s ability to successfully receive oral health care services. The Office of Patient Services: Bringing Smiles to Patient Care (OPS) was established to provide patient-focused care, transformative-interprofessional education, social work practice and community engagement. However, there is a gap in systematically documenting the reasons for social work involvement in patient interactions in the dental clinic. The aim of this study was to categorize and analyze the most common patient interactions with social work to develop a working coding taxonomy. The hope is to use this documentation system as a tool to better inform dental school clinic practices for enhanced dental student education and comprehensive patient-focused care.

Methods: Using OPS’ Patient Tracker data of patients who interacted with social work at CDM from April 2015 to June 2019 (N=743), a retrospective review was conducted to categorize and later analyze the most common referrals to social work. Each referral was extracted, reviewed and coded using an adapted Rutgers School of Dental Medicine patient complaint taxonomy. Extracted data was collected using an Excel document and analyzed to determine the frequency of each type of referral, referral source, domain, category, and sub-category. To increase reliability, authors reviewed 100 as a group to clarify the coding taxonomy. Referrals were excluded if information was left blank in the Patient Tracker.

Results: From April 2015 to June 2019, 743 referrals were made to OPS with 83.18% (618/743) on behalf of the patient, 16.42% (122/743) as self-referrals and 0.40% (3/743) on behalf of dental providers. Four main domains emerged from the analysis, with the most frequent being Psychosocial (40.38%), followed by Dental Clinic (32.97%), Institutional (24.76%), and Consultation (1.88%). Within the domains, the categories that were most prevalent were Care Coordination (19.11% of Psychosocial), Quality of Care (25.17% of Dental Clinic), Financial (13.86% of Institutional), and Interprofessional Discourse (1.88% of the Interprofessional Discourse). Additionally, within categories, the most common subcategories included, OPS Support/Assessment (10.68% of Care Coordination), Appointment Adherence (9.69% of Quality of Care), Insurance Issues (5.92% of Financial), and 1:1 Guidance and Support (1.75% of Interprofessional Discourse).

Conclusion and Implications: Dental providers often struggle to best address their patient’s biopsychosocial barriers to care. Through developing a dental clinic social work coding taxonomy, we found that social work services were most commonly being utilized at CDM to navigate psychosocial and clinical barriers to oral health care. Future research can explore the short and long-term outcomes of patients and dental students’ collaboration with social work. As social work continues to emerge in dentistry, it is essential to build best practice models to better inform clinic programs, policy, and student education, for enhanced patient-focused care.