How Integrated Are Social Workers and Community Health Workers in Healthcare and Public Health Settings? a Mixed Methods Assessment

Background & Purpose: Collaboration between community health workers (CHWs) and social workers (SWs) is crucial to address complex social determinants of health and advance health equity. Both professions address health related social needs (HRSN), yet there is a paucity of literature on their integration within healthcare and public health systems. Therefore, the purpose of this study was to assess the level of integration among four healthcare and public health organizations that have integrated CHWs and SWs into their programming.

Methods: A national workgroup of SWs and CHWs conducted a national, mixed-methods study with four health or community-based organizations in different states (California, Texas, New Jersey, and South Carolina) that integrated CHWs and SWs into their services. SWs (n=15) and CHWs (n=16) completed online surveys about collaboration and integration, followed by 90-minute virtual focus groups. Descriptive statistics were utilized with quantitative data, and thematic analysis was conducted by two qualitative coders to identify themes related to collaboration and integration.

Results: Respondents reported relatively high levels of integration in quantitative surveys. Integration and collaboration were assessed based on shared physical space, shared documentation, shared scheduling, shared tasks, and frequency of meetings. 72% of respondents reported “never” or “rarely” working in separate facilities from their counterparts (CHWs or SWs). 85% of respondents reported “never” or “rarely” documenting in a separate system from their counterparts, and 86% of respondents reported sharing a scheduling system “often” or “very often.” Respondents also reported shared tasks including meeting “often” or “very often” (71%) and “often” or “very often” sending referrals to their counterparts (55%). 97% of CHWs and SWs reported that their counterparts understood their roles “often” or “very often.”

Qualitative focus groups revealed additional nuances regarding how integration varied among the four organizations. For example, the frequency and method for regular communication varied based on the organization’s infrastructure. For CHWs and SWs that were embedded within a Medicaid plan, regular communication often happened within the shared EMR system. For CHWs and SWs that worked in community-based settings that did not have the same level of digital infrastructure, communication happened during weekly multidisciplinary meetings or case consultations. Respondents also indicated opportunities for improved integration such as leadership buy-in, adequate funding and/or staffing, and standardized, interdisciplinary training to delineate referral processes and improve communication practices.

Conclusions & Implications:

Effective collaboration between SWs and CHWs fosters patient-centered care and enhances care coordination. Effective integration of CHWs and SWs into healthcare systems improves patient experience and strengthens overall capacity to address the multifaceted needs of individuals and communities. Our findings demonstrate that while SWs and CHWs may be involved in collaborative activities, there are variations in implementation, impacting the level of integration at the organizational or systems level.

These findings will inform training and advocacy efforts by the CHW and SW National Workgroup to improve CHW and SW collaboration and integration to advance health equity. Future research could explore variations in the implementation of CHW and SW collaboration from the perspective of social work leadership and public health administrators.