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MAKING THE INVISIBLE VISIBLE: Are Medical Social Workers Addressing the Social Determinants of Health? PowerPoint Presentation
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Shelley L. Craig, PhD, RSW Assistant Professor Raluca Bejan MSW student Barbara Muskat , PhD, RSW Social Work Director, The Hospital for Sick Children. MAKING THE INVISIBLE VISIBLE: Are Medical Social Workers Addressing the Social Determinants of Health? . Purpose .

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slide1

Shelley L. Craig, PhD, RSW

Assistant Professor

RalucaBejan

MSW student

Barbara Muskat, PhD, RSW

Social Work Director, The Hospital for Sick Children

MAKING THE INVISIBLE VISIBLE: Are Medical Social Workers Addressing the Social Determinants of Health?

purpose
Purpose
  • This study explores if health social workers (HSWs) are addressing the vast range of social determinants of health (SDH) within their practice.
social determinants of health
Social Determinants of Health
  • It is increasingly recognized that the social determinants of health and the associated health disparities cannot be addressed without intervention in the social circumstances of patients (Schrecker, Chapman, Labonte, & De Vogli, 2010).
  • This is a role that, historically, has been fulfilled by social workers in the health care system.
health social work
Health Social Work
  • Health social workers (HSW) bring an ecological perspective to health care, by incorporating a full range of psychological and emotional factors (Rachman, 1995) and attention to how individuals interaction with larger social systems influences their health (Claiborne & Vandenburgh, 2001).
  • HSW work collaboratively as part of institutional and community interprofessional teams to support recovery, to promote quality of life in the context of chronic illness and disability, and to advocate for societal change to address social disadvantages (Praglin, 2007).
the changing nature of health social work
The Changing Nature of Health Social Work
  • Social workers delivering services in health care face unique challenges and opportunities in a rapidly changing environment (Kim & Lee, 2009).
    • Almost 50% of all registered SWs in the province of Ontario are employed in medical settings
  • We talk about how we influence the SDH but how?
social determinants of health sdh
Social Determinants of Health (SDH)
  • SDH have been defined as the cumulative environmental factors shaping individuals’ health status
  • SDH are leveled along several axes of social stratification
    • Socio-Economic Status (SES)
    • Social Supports
    • Diversity & Equity
    • Health Care Services
social determinants of health sdh1
Social Determinants of Health (SDH)

SES

  • Income & its Distribution
  • Unemployment &

Employment Security

  • Education
  • Employment &
  • Working Conditions
  • Early Life
social determinants of health sdh2
Social Determinants of Health (SDH)

SOCIAL SUPPORTS

  • Housing
  • Social Safety Net
  • Food Security
social determinants of health sdh3
Social Determinants of Health (SDH)

DIVERSITY & EQUITY

  • Gender
  • Racism
  • Aboriginal Status
  • Disability Status
  • Social Exclusion
methods
METHODS
  • Survey of SW professionals (n= 54) employed at major hospitals across Toronto
  • Measures:
    • Basic demographic information (age, race, gender identity, sexual orientation, educational degree)
    • Job details (number of years in social work practice, number of years in a health care setting, job title)
    • Number and type of SDH addressed through public health practice
  • Analyses:
    • SPSS 19.0: descriptive statistics, correlations and chi-square analyses
discussion
Discussion
  • Social workers in health care are actively addressing the social determinants of health in their daily practice
    • Specifically, SWs are addressing SES(Income Distribution and Unemployment)and Social Supports (Housing and the Social Safety Net)
    • Statistically significant correlations were observed with the variables of each SDOH construct (egthose actively addressing Housing were also more likely to address the Food Security and Social Safety Net determinants)
  • SDH related to Diversity and Equity, such as Racism, Aboriginal Status, Gender and Social Exclusion, are not addressed as frequently in daily practice
    • Statistically significant associations - SWs failing to address one determinant might innately leave the subsequent other unaddressed
discussion1
Discussion

The focus on proximal/ tangible SDH may be related to:

1) The short term nature of patient contact in health/hospital social work

2) The needs of the health care setting and the reason social workers are hired

3) The importance of addressing the most pressing needs first (food).

4) The limitations faced by HSW practicing in health care systems to address complex determinants

This means that the presence of HSW is incredibly important for the most vulnerable populations YET

Social workers expressed guilt that they werent addressing the most complex determinants and seemed to brush over the provision of tangible benefits.

conclusions
Conclusions
  • Social work practice in health is now at crossroads
  • It needs to critically examine its ability to establish a social justice framework and apply a bio-psycho social perspective within these settings.
  • Future research should incorporate more comprehensive measures of SDH and investigate the ways in which client outcomes are influenced by SW interventions
references
References

Auerbach, C., Mason, S.E., & Heft-LaPorte, H. (2007). Evidence that supports the value of social work in hospitals. Social Work in Health Care, 44(4), 17-32.

Auerbach, C. & Mason, S. (2010). The value of the presence of social work in Emergency Departments, Social Work in Health Care,49(4), 314-326.

Barbour, R. S. (2005). Making sense of focus groups. Medical Education, 39(7), 742-750. doi: 10.1111/j.1365-2929.2005.02200.x

Bronstein, L., Kovacs, P., & Vega, A. (2007). Goodness of fit. Social Work in Health Care, 45(2), 59-76.

Burg, M., Zebrack, B., Walsh, K., Maramaldi, P., Lim, J., Smolinski, K., et al. (2010). Barriers to accessing quality health care for cancer patients: A survey of members of the Association of Oncology Social Work, Social Work in Health Care, 49(1), 38-52

Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks, CA: Sage Publications.

Cohen, J.A. (2003). Managed care and the evolving role of the clinical social worker in mental health. Social Work, 48(1), 34–43.

Claiborne, N. & Vandenberg, V. (2001). Social workers role in disease management. Health and Social Work, 26(4), 217-225.

Egan, M., & Kadushin, G. (2004). Job satisfaction of home health social workers in the environment of cost containment. Health and Social Work, 29(4), 287–196.

references1
References

Gibbons, J. & Plath, D. (2009). Single contacts with hospital social workers: The clients experiences. Social Work in Health Care, 48(8), 721-735.

Holliman, D.C., Dziegielewski, S.F., & Priyadarshi, D. (2001). Discharge planning and social work practice. Social Work in Health Care, 32(3), 1–19. doi:10.1300/J010v32n03_01

Kasperski, J., Power, K., & VanderBent, S.D. (2005). Social work, primary care and Family Health Teams in Ontario: Delivering comprehensive family-centered care. Joint paper by the Ontario College of Family Physicians (OCFP), the Ontario Association of Social Workers (OASW) and the Ontario Home Care Association (OHCA).

Kim, H. & Lee, S. (2009). Supervisory communication, burnout, and turnover intention among social workers in health care settings. Social Work in Health Care, 48(4), 364-385. doi: 10.1080/00981380802598499.

Lechman, C. & Duder, S. (2009). Hospital length of stay: Social work services as an important factor, Social Work in Health Care, 48(5), 495-504.

Mizrahi, T. & Berger, C. (2005). A longitudinal look at social work leadership in hospitals: The implications of a changing health care system. Health and Social Work, 30(2), 155-165

Proctor, E.K. (2002). Social work research: Informing the frontlines and taking the long view. Social Work Research, 26(3), 130–131.

QSR International (2006). NVivo7. OSR International Pty Ltd., www.qsrinternational.com

Richards, L. (1999). Data alive! The thinking behind NVivo. Qualitative Health Research, 9(3), 412-428.

Salvatore, E.P. (1988). Issues in collaboration and teamwork: A sociological perspective on the role definition of social work in primary health care. Research in the Sociology ofHealth Care, 7, 199-239.

thank you
Thank You!
  • Shelley L. Craig, PhD, RSW
    • Shelley.craig@utoronto.ca