The Benefits and Challenges of Telehealth for Patients of Outpatient Health Care Social Workers

Background and Purpose: Health care social workers were thrust rapidly into telehealth utilization due to the COVID-19 pandemic. There is prolific research on the benefits and challenges of telehealth, but little focusing on outpatient health care social worker interventions. This is significant because telehealth is currently transitioning from a strategy for maintaining health services, to an established service modality. This study explores health care social workers’ experiences employing telehealth during the pandemic, and the impact on their focal populations, the vulnerable and oppressed. Participants identified specific contextual processes and factors that affected their telehealth interventions with patients, and exacerbated or mitigated health care inequities.

Methods: This study utilized a qualitative descriptive design. A purposeful, homogeneous sampling strategy was used to recruit twenty-one outpatient health care social workers. Participants served in three roles, case management and counseling (47%), integrated behavioral health (24%), and therapy (29%), and practiced in nine outpatient clinics across two urban medical centers serving safety net patients. Recruitment was by email from this investigator, forwarded to all outpatient social workers by their managers. Semi-structured interviews were conducted during the summer of 2022 to elicit their experiences using telehealth during the pandemic, benefits and challenges of its use, and its effects on patients. Interviews were administered over Zoom, audio-recorded externally, and transcribed verbatim. Inductive, thematic analysis was utilized to identify themes across the interviews. Dedoose, a web-based qualitative data analysis application, was used to organize the analysis.

Results: Despite initial institutional challenges involving a steep learning curve, and resource procurement, participants expressed universal confidence in telehealth as an effective service model, and a desire for its continuance as a service option. They identified multiple challenges telehealth presents for patient care access, including unaffordable technological equipment and resources, and lack of private and/or safe spaces for meeting. Other identified barriers to optimal social work interventions were age (kids, teens, older adults), need for language interpreter, mental illness symptoms, patient behavior, and inferior quality of the telehealth modality for nonverbal interpretation and expression. Participants also identified multiple barriers to health care access that are mitigated by telehealth, including travel distance and cost, inability to travel during the workday, childcare, physical illness and disability, and mental illness symptoms. Participants offered universally that telehealth decreased appointment no shows. The ability to observe patients and their families in their natural environments and their perceived tendency to share more in the comfort of their own homes were identified as elements of telehealth that improve social work interventions. Finally, participants offered suggestions for improvement.

Conclusion: This study illuminates varied challenges and benefits of telehealth to the vulnerable patients seen by outpatient health care social workers. As telehealth becomes embedded as a service option it is important to expand research on the contextual factors that drive benefits and harms of this modality so social workers can advocate for discernment and resources in its use for the benefit of their patients.