The Value of Social Work in Health: Findings from a Scoping Review

Objective: Social workers are an integral part of the US healthcare system, yet research on specific contributions of social work practice to health and cost-containment outcomes is sparse. This scoping review describes and evaluates the state of the evidence on social work on health and economic outcomes since the passage of the Affordable Care Act (ACA) in 2010. Given that scoping reviews are most appropriate for describing the state of the research evidence and identifying trends and gaps in the literature (Munn et al., 2018; Tricco et al., 2018), findings are reported accordingly.

Method: Three databases (PubMed, PsycINFO, CINAHL) were searched using the convention: [“social work” OR “social services”] AND "health" AND ["cost" OR "utilization" OR “readmission”] for studies published between 2010 and 2022. Unique records were evaluated on inclusion criteria (US-based; reported social work and cost or health outcomes) and evaluated using Arksey & O’Malley’s (2005) five-phase scoping review process. Methodological quality was assessed using two validated metrics: the Quality Checklist for Randomized Controlled Trials and Observational Studies (QC-RCT/OS; Downs & Black, 1998) and the Quality of Health Economic Studies (QHES; Offman et al., 2003).

Results: Of 1,655 unique records retrieved, 40 (2.4%) met inclusion criteria. Full text review yielded 15 studies, comprising the final sample. Most studies (75%) described transitional care interventions for older patients and high utilizers of health services, with the majority (75%) led by social workers. While health and cost outcomes were generally positive, analyses revealed several additional trends and gaps in the literature across four main areas: 1) study design and economic evaluation methods, 2) sample composition, 3) measurement, and 4) range of target problems and associated interventions. Overall methodological quality of the sample was low according to QC/RCT-OS and QHES metrics, in large part due to lack of comparison groups within studies and a nearly exclusive reliance on cost savings methodology. A third of included studies did not report demographic characteristics; six of the 10 that did report these data described samples of predominantly white adult participants. No studies reported gender outside of male/female binary classifications and only one study was conducted with children/youth. Most studies (73.3%) relied exclusively on utilization data in place of self-reported or clinician-assessed health outcomes, and no studies focused on primary prevention.

Conclusion: The four gaps identified in this review represent opportunities for future research on social work practice that may inform health system innovation and investment planning. Improving the quality of data collected will be critical, as omissions of demographic information about study participants obscure information about the utility of interventions/models of care delivery; which in turn interfere with social work’s ability to center racial equity and social justice through research, practice, and policy. Future research in this arena should report demographic information as well other sociodemographic factors and social determinants, including concerns about racism, discrimination, disparities, and inequities; include more robust economic analyses, and evaluate a range of interventions (including prevention-oriented programs) with diverse populations across the lifespan.