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Evidence shows that when an interprofessional (IP) approach is effectively implemented, it can counteract some of our most pressing health care problems. One such challenge is the lack of training in IP teamwork health care professionals receive during their education. Using a quasi-experimental matched comparison group design, this study assessed pre- and posttest changes in IP knowledge, attitudes, and skills of MSW students (N = 52) from 2015-2017, who received a specialized curriculum, and clinical internships working in IP teams, compared to an internal control group involving clinical IP teams alone. Two validated measures assessed changes in students' IP knowledge, values, and skills. Quantitative findings and qualitative responses to open-ended questions elucidate barriers and facilitative factors in IP teams.

Behavioral health needs continue rise in the United States and constitute a key driver of health care utilization, costs, and outcomes. Social workers provide a wide range of services across health, behavioral health, and community settings, and while this heterogeneity in practice benefits care delivery, it complicates health workforce analyses. This analysis compares five commonly used national data sources and details similarities and differences in their estimates of the number, type, and practice characteristics of social workers. The analysis suggests that estimates vary significantly between data sets ranging from 282,425 to 1,022,859 social workers; as well as yield different findings of types of social workers in the United States, depending on the data set used. These differences have the potential to shape how researchers and policy makers assess the adequacy of the social work workforce and identify solutions to address the nation's behavioral health and social care needs. [ABSTRACT FROM AUTHOR]

Introduction: Integrated health care is utilized in primary care clinics to meet patients' physical, behavioral, and social needs. Current methods to collect and evaluate the effectiveness of integrated care require refinement. Using informatics and electronic health records (EHR) to distill large amounts of clinical data may help researchers measure the impact of integrated care more efficiently. This exploratory pilot study aimed to (a) determine the feasibility of using EHR documentation to identify behavioral health and social care components of integrated care, using social work as a use case, and (b) develop a lexicon to inform future research using natural language processing. Method: Study steps included development of a preliminary lexicon of behavioral health and social care interventions to address basic needs, creation of an abstraction guide, identification of appropriate EHR notes, manual chart abstraction, revision of the lexicon, and synthesis of findings. Results: Notes (/V = 647) were analyzed from a random sample of 60 patients. Notes documented behavioral health and social care components of care but were difficult to identify due to inconsistencies in note location and titling. Although the interventions were not described in detail, the outcomes of screening, referral, and brief treatment were included. The integrated care team frequently used EHR to share information and communicate. Discussion: Opportunities and challenges to using EHR data were identified and need to be addressed to better understand the behavioral health and social care interventions in integrated care. To best leverage EHR data, future research must determine how to document and extract pertinent information about integrated team-based interventions. Public Significance Statement This paper assesses the feasibility of EHR (electronic health record) documentation to better understand aspects of integrated care that address behavioral health and social needs. More information on these aspects of care can help health systems identify, track, and evaluate the delivery of integrated care and how it may be improved to meet an individual's whole-health needs. Keywords: electronic health records, integrated care, team-based care, behavioral health providers, natural language processing (NLP) Supplemental materials: https://doi.org/10.1037/fsh0000584.supp, Health systems are rapidly implementing integrated health models in primary care clinics (Balasubramanian et al., 2017; Blount & Miller, 2009; Butler et al., 2008), and with good reason. Evidence indicates [...]

Purpose: This study assesses how, among behavioral health clinicians working in rural safety net practices, the amount of exposure to care in rural underserved communities received during training relates to confidence in skills important in their work settings, successes in jobs and communities, and anticipated retention. Methods: This study uses survey data from Licensed Clinical Social Workers, Licensed Professional Counselors, and Psychologists working in rural safety net practices in 21 states while receiving educational loan repayment support from the National Health Service Corps, from 2015 to April 2022. Findings: Of the 778 survey respondents working in rural counties, 486 (62.5%) reported they had formal education experiences with medically underserved populations during their professional training, for a median of 47 weeks. In analyses adjusting for potential confounders, the estimated amount of rural training exposure was positively associated with a variety of indicators of clinicians' integration and fit with their communities as well as with longer anticipated retention within their rural safety net practices. The amount of training in care for rural underserved populations was not associated with clinicians' confidence levels in various professional skills or successes in their work, including connection with patients and work satisfaction. Conclusions: Formal training in care for underserved populations is a large part of the education of behavioral health clinicians who later work in rural safety net practices. More training in rural underserved care for these clinicians is associated with greater integration and fit in their communities and longer anticipated retention in their practices, but not with skills confidence or practice outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Evidence supports that integrated behavioral health care improves patient outcomes. Colocation, where health and behavioral health providers work in the same physical space, is a key element of integration, [...]

Value-based payment models may improve patient health by targeting quality of care over quantity of health services. Social workers in primary care settings are well-positioned to improve the quality of health services for vulnerable patients by identifying and addressing patients' social determinants of health. This case study describes a Plan Do Study Act (PDSA) quality improvement approach implemented and refined by social workers to proactively address clinical quality gaps in one family medicine practice. The studied program – entitled Gap Closure Day – was led by a team of social workers to improve quality outcomes of patients. Findings highlight the important roles of social workers as members of health care teams to improve the quality of health services and address health equity. [ABSTRACT FROM AUTHOR]

Introduction: Despite evidence to support the integration of behavioral health and physical health care, the adoption of Integrated Behavioral Health (IBH) has been stymied by a lack of reliable and sustainable financing mechanisms. This study aimed to provide information on the use of Psychiatric Collaborative Care Model (CoCM) and behavioral health integration (BHI) codes and the implementation of IBH in federally qualified health centers (FQHCs). Method: This cross-sectional, mixed-methods study involved an electronic survey of administrators and follow-up qualitative interviews from a subset of survey respondents. Quantitative data were analyzed using descriptive analysis and thematic coding was used to analyze qualitative data to identify salient themes. Results: Administrators (N = 52) from 11 states completed the survey. Use of CoCM (13%) or BHI codes (17.4%) was low. Most administrators were not aware that CoCM (72%) or BHI codes (70%) existed. Qualitative interviews (n = 9) described barriers that further complicate IBH and code use like workforce shortages and insufficient reimbursement for the cost to deliver CoCM services. Discussion: Although FQHCs are working to meet the needs of the communities they serve, a lack of billing clarity and awareness and workforce issues hinder the adoption of the CoCM. FQHCs face many demands to provide care to safety net populations, yet are not fully equipped with the resources, workflows, staffing, and payment structures to support CoCM/BHI billing. Increased financial and logistical support to build practice infrastructure is needed to reduce the administrative complexity and inadequate reimbursement mechanisms that currently hinder the implementation of the CoCM and integrated care delivery. Public Significance Statement: Federally qualified health centers (FQHCs) are increasingly delivering behavioral health treatment, in part through integrated behavioral health (IBH) service delivery; yet financing structures like CMS (Center for Medicare and Medicaid Services) codes for the Collaborative Care Model (CoCM) and behavioral health integration may not be widely understood due to administrative complexity, nor may it be sufficient enough to incentivize their use. FQHCs need financial, logistical, and technical assistance to jump-start use of CMS codes for IBH, as well as needing payment reform to support use of these codes. [ABSTRACT FROM AUTHOR]

Social work has seen significant federal investment through the Behavioral Health Workforce Education and Training (BHWET) for Professionals grants. This research note examined differences between BHWET trainees and general MSW graduates regarding self-reported knowledge of integrated behavioral health competencies, job placement, and starting salaries. A survey was administered 10 months after graduation (N=288) for five graduating classes (2014-2018). Bivariate two-tailed t-tests and Fisher's exact tests examined group differences. BHWET participants rated interprofessional abilities and integrated care skills significantly higher; were significantly more likely to secure employment quicker; work on interprofessional teams; and earn higher salaries, compared to counterparts. Demonstrating the effectiveness of workforce initiatives is necessary to document best practices and continue federal investment in the social work workforce. [ABSTRACT FROM AUTHOR]

A qualitative study was conducted to understand how social workers document their work in the electronic health record (EHR) in integrated primary care settings. Three themes emerged from the analysis of the focus groups: 1) considerable variability in where and how social workers document their practice within the EHR; 2) EHR functions are not designed for social work practice; and 3) EHR documentation practices as helpful for demonstrating social workers' contributions to other integrated care team members. Education, training, and EHR adaptations are needed as social workers and other nontraditional healthcare providers continue to partake in team-based service delivery, especially in integrated primary care. [ABSTRACT FROM AUTHOR]

Background: Youth from marginalized groups may be less likely to receive quality health care services. Adverse Childhood Experiences (ACEs) are known to impact long-term health, but it is unclear if there is a relationship between ACEs and receipt of Family Centered Care (FCC)—one indicator of high-quality health care. To assess this relationship, this study used a nationally representative sample of youth from the National Survey of Children's Health 2016–2017 combined data set. Caregivers of children who had at least one health care visit in the last 12 months (sub-sample n = 63,662) were asked about five indicators of FCC including if they felt the provider: (1) spent enough time, (2) listened carefully, (3) helped family feel like a partner, (4) provided information requested, and (5) showed sensitivity to culture. Methods: Logistic regression analyses examined the association between ACE score and each FCC quality indicator, as well between ACEs score and the overall FCC dichotomous score. Results: ACE exposure did not significantly predict access to a health care visit in the past 12 months. However, children with higher rates of ACEs were significantly less likely to receive FCC. Other factors that significantly predicted lower FCC included child race and ethnicity, insurance type, language in the home, and access to a regular health provider. Conclusions: Providers and health systems must identify, implement, and advocate for effective trauma-informed and care coordination interventions that ensure quality health care services for vulnerable children and families. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine how well Electronic Health Record (EHR) documentation identifies which health professionals act to address patient social determinants of health (SDOH) and what interventions are documented. The Electronic Medical Record Search Engine was used to identify food and housing insecurity EHR notes. From the notes, researchers randomly sampled 60 from each SDOH category. Of 120 notes, which contained a reference to food or housing insecurity, 72% also contained information on an intervention taken. Interventions were documented by social workers 63% of the time, followed by dietitians and physicians. Addressing patient SDOH is a crucial part of comprehensive healthcare. Findings contribute to a broader conversation on the documentation and interventions in healthcare settings to address patients' SDOH. Findings support the critical importance of standardizing SDOH documentation in the EHR across more members of the health workforce to ensure patient needs are met. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 pandemic disrupted access to and the delivery of behavioral health services for social work providers and their clients. This study examined the use of tele-behavioral health by social workers before and during the pandemic, as well as the perceived barriers and supports to technology use. Method: We developed an electronic survey, which was distributed to a convenience sample of practicing social work professionals in the United States through a national listserv. A mixed-methods study design was used to analyze responses (N = 585). Results: Over 92% of social workers reported using tele-behavioral health since the beginning of the pandemic, compared to 28% prior. About half of respondents received training on tele-behavioral health since COVID-19, whereas only 23% had received training prior. The vast majority (87%) indicated one or more barriers to the use of tele-behavioral health, with client barriers (73%) being the area of greatest concern. Yet, social workers overwhelmingly reported the desire for tele-behavioral health to continue beyond the pandemic. Conclusions: Based on our findings, we propose the following recommendations: (a) Ensure parity and reimbursement for tele-behavioral health; (b) train current and future social work practitioners in tele-behavioral health; and (c) provide supports for client use of tele-behavioral health. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs), often defined as potentially traumatic experiences such as child maltreatment and household difficulties (e.g., caregiver substance misuse) that occur prior to age 18, are associated with poor health and psychiatric illness across the life span and have been increasingly used as a predictor of health outcomes in both research and practice. However, limited research has explored who should be reporting ACEs for children or to what extent reporters agree on observations of ACE exposure. This study examines respondent agreement among children, caregiver, and caseworker using data drawn from the National Survey of Child and Adolescent Well-being (NSCAW II), a longitudinal, nationally representative survey of children who have been the subject of a child welfare investigation. A sub-sample of participants aged 8–17 was used (n = 1,652). The following ACE indicators had responses from all three respondents: sexual victimization, physical abuse, emotional abuse, and home violence. Analyses were completed to understand patterns of reporter's responses to each of the ACEs selected using sampling weights. We calculated interrater agreement using the Kappa coefficient for each ACE indicator. Children, caregivers, and caseworkers differentially reported the number of ACEs the child experienced. Children reported experiencing just over two ACEs on average, while caregivers reported two and caseworkers reported an average of one. Overall, Kappa coefficients were extremely low with caseworker-caregiver agreement the highest at.41. Given the lack of concordance, we recommend asking multiple informants while carefully considering self-report by children when assessing for ACEs. [ABSTRACT FROM AUTHOR]

Emerging adults are at high risk for opioid-use disorders (OUDs); however, their service use and co-occurring needs are infrequently described. This study analyzed county-level Medicaid claims across 3 years (2016–2018). A total of 1,665 individuals aged 17–25 received OUD services. More than 54% of the sample received services for a co-occurring mental health (MH) disorder. Only 21.3% received medications for OUDs (MOUDs), yet those with co-occurring MH were less likely to receive MOUDs and more likely to receive high-intensity services. This article will describe the characteristics of OUD and co-occurring treatment for emerging adults and address implications for social work. [ABSTRACT FROM AUTHOR]

Exposure to childhood victimization and adversity (CVA) is pervasive for child welfare (CW) involved youth. However, most research with CW samples has focused on types of maltreatment and fails to recognize the additive influence of exposure to CVA beyond maltreatment. A subsample aged 8 to 17 (n = 1,887) was drawn from the National Survey of Child and Adolescent Well-Being (NSCAW) II. CVA included six domains. Behavioral health was assessed using the Child Depression Inventory, Trauma Symptom Checklist, and the internalizing and externalizing subscales of the Child Behavior Checklist. Logistic regression was used to explore the association between the number of CVA reported and the risk of clinical-range behavioral health symptoms. Analyses were adjusted for the cluster-based sampling design and sampling weights were applied to provide nationally representative estimates. More than 60% of the sample experienced three or more CVA domains. The number of CVAs reported was associated with all four behavioral health outcomes (p <.001). Children exposed to five or more domains were more likely to report high depressive symptoms (odds ratio [OR] = 5.0), high trauma symptoms (OR = 7.0), and to have internalizing or externalizing symptoms reported by caregivers (OR = 18.0), as compared with children reporting one or less CVAs. Youth involved with CW are exposed to staggeringly high rates of CVA beyond maltreatment. For children who are already at great risk for behavioral health challenges, research to understand screening and interventions for CVA is needed to inform policy and practice initiatives to prevent and mitigate harm. [ABSTRACT FROM AUTHOR]

Purpose: To identify the strategies and interventions U.S. health systems implemented to reduce burnout and increase employee well-being during the first year of the COVID-19 pandemic. Methods: A concurrent design included a scoping review of published literature on burnout interventions implemented for healthcare workers during COVID-19 and expert interviews with healthcare administrators involved in COVID-19 burnout response efforts (N = 5). Scoping review protocols included a-priori inclusion criteria, search terms, database selection, and data abstraction (N = 21 articles). Results: The scoping review identified eight types of interventions; spanning individual, organizational, and community systems. Qualitative data supported scoping review findings and uncovered themes related to communication, role shifting, and wellness initiatives as forms of burnout prevention and reduction. Conclusion: As COVID-19 continues, so too will worker stress, burden, and burnout. Health systems worked quickly and creatively to address the needs of the frontline healthcare workforce, yet more work is needed to sustain efforts over time. [ABSTRACT FROM AUTHOR]

Purpose: Social work (SW) is a profession that fulfills important roles on integrated health teams, yet there remains a lack of clarity on SW's functions. The current study sought to identify typologies of SW's roles on integrated care teams using latent class analysis (LCA). Method: An electronic survey was developed, piloted, and administered to Masters level SW students and practitioners in integrated health care settings (N = 395) regarding weekly use of interventions. LCA was conducted to estimate latent sub-groups of respondents. Results: Respondents reported an average of 14.6 (SD = 4.7) interventions. Five classes of SW roles were identified and varied by setting and focus. One class (13%) completed a hybrid function providing behavioral health and social care interventions. Conclusions: Classes of SW roles on teams may reflect varying models of integrated care. A flexible SW on the team may adapt to patient and clinic needs, but increases the opportunity for role confusion. [ABSTRACT FROM AUTHOR]

This study examines the prevalence of trauma subtypes, polytraumatization, and perinatal depression (PND) in a diverse sample of adolescent mothers to help inform PND prevention, screening, and treatment efforts. We conducted a secondary analysis of a sample (N = 210) of adolescent mothers aged 14 to 20 years from a prospective longitudinal study of PND. Participants were recruited from a county-based, public health prenatal clinic, and data were collected in the prenatal and postpartum periods. In this sample, 81% of adolescent mothers reported at least one trauma experience and 75% reported lifetime experience of intimate partner violence (IPV). The most prevalent trauma types among adolescent mothers reporting PND were sexual trauma prior to age 13 (11.9%), loss of a caregiver or sibling (28.3%), emotional adversity (17.1%), and polytraumatization (43%). Trauma is alarmingly prevalent among adolescent mothers. Results suggest standards of care for adolescent mothers should include screening adolescent mothers for trauma history and provision of appropriate referrals for IPV. Findings support the need for trauma-informed treatment in perinatal public health clinics to decrease potential health risks to both mother and baby. [ABSTRACT FROM AUTHOR]

Objective : Medication-assisted treatment (MAT) in office-based opioid treatment (OBOT) is expanding treatment of opioid use to primary care settings. OBOT combines MAT and behavioral health interventions; however, the literature varies on best practices. This review focuses on psychosocial interventions as an OBOT component. Method: Protocol and eligibility criteria were published on PROSPERO; intervention characteristics, setting, provider, location, and duration were considered. Results: Search results and initial screening yielded 539 articles for abstract review; 67 articles were retained for full-text review. Of these, 30 articles (reporting on 25 studies) met inclusion criteria. The majority of studies were conducted in academic medical centers (72%), primarily in the Northeast U.S. Study samples consisted of a majority of men and White participants. Psychosocial interventions included individual counseling (88%), mutual help programs (36%), group counseling (28%), case management (24%), and referral to outpatient treatment (24%). Therapeutic approaches used motivational interviewing, cognitive behavioral therapy, and 12-step facilitation. Interventions were administered by interprofessional providers—most frequently medical providers, social workers, and a variety of behavioral health providers. Conclusions: Despite progress in expanding OBOT, a critical need remains to identify and support psychosocial interventions as essential, concurrent components of MAT. Implications for practice, workforce, team-based care, and future research needs are addressed. [ABSTRACT FROM AUTHOR]

Social workers are increasingly working in primary care clinics that provide Integrated Behavioral Healthcare (IBH) in which a patient's physical, behavioral, and social determinants of health are addressed on a collaborative team. Co-location, where care is housed in the same physical space, is a key element of IBH. Yet, little is known about the rate of social workers co-located with primary care physicians (PCPs). To identify national rates of social worker co-location, data were drawn from the Centers for Medicare and Medicaid (CMS) National Plan and Provider Enumeration System (NPPES; n = 232,021 social workers, n = 380,690 PCPs). Practice addresses were geocoded and straight-line distances between practice locations of social workers and PCPs were calculated. More than 26% of social workers were co-located with a PCP. However, in rural settings only 21% were co-located (p <.001). Co-location also varied by PCP practice size, specialty, and state. This study serves as a benchmark of the growth of IBH and continued monitoring of co-location is needed to ensure social work workforce planning and training are aligned with changing models of care. Further, identifying mechanisms to support social work education, current providers, and health systems to increase IBH implementation is greatly needed. [ABSTRACT FROM AUTHOR]

The opioid epidemic is a national emergency in the United States. To meet the needs of individuals diagnosed with Opioid Use Disorder (OUD) office-based opioid treatment programs (OBOT) are quickly expanding. However, social workers roles in OBOT programs are not clearly described. This paper will emphasize three roles social workers may fulfill in OBOT programs to combat the opioid crisis. [ABSTRACT FROM AUTHOR]

Great strides have been made in highlighting the strengths of the social work profession as a workforce vital to improving the health and well-being of individuals, families, and communities. Nevertheless, substantially more work is needed to advance education, practice, and research involving social workers' potential and their contributions to improved care throughout the life course. This special issue offers exemplars of the power of social work in integrated settings with the capacity to address the scope of behavioral health, psychosocial, and physical health care needs. In today's rapidly evolving heath care context, integrated care represents a promising direction for the future of health services, and may be leveraged to improve population health across the life course. Papers selected for this special issue focused on two themes: (a) defining the expanding roles and functions social workers fulfill in integrated health settings, and (b) identifying organizational and system factors that affect social workers' delivery of interventions in integrated health models. This special issue further articulates the added-value of social workers on health care teams and the resulting improved outcomes for patients, families, and communities. Through increased evidence, such as the knowledge gained from this special issue, it is our hope that the profession continues to advance the boundary-spanning roles and capabilities of social workers in integrated health settings—both in the hospital and in community-based settings. [ABSTRACT FROM AUTHOR]

Using a sample of 390 stepparents, we assess the influence of insecure attachment and couple relationship quality on stepparenting issues. We also examine the extent to which relationship quality mediates connections between attachment and stepparenting issues. Results from ordinary least squares regression and Sobel tests indicate greater levels of attachment avoidance and anxiety are associated with greater levels of stepparenting issues. Results also indicate greater levels of relationship satisfaction and stability are associated with less stepparenting issues. Relationship satisfaction and stability significantly mediate the influence of attachment anxiety on stepparenting issues. Limitations, implications, and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

As the United States faces burgeoning behavioral health needs and a growing recognition of the inextricable link between social conditions and health outcomes and quality-of-life indicators, a current representative profile of the MSW workforce with respect to sociodemographic and employment characteristics can provide a reference point for ongoing assessments of that workforce. The profile also can establish a baseline by which efforts to bolster the diversity and strength of the MSW workforce can be grounded. The core aim of the current study was to generate a nationally representative, descriptive profile of MSW graduates in the United States using a sample of 1,028 MSW graduates (representing a subpopulation of 691,061 individuals) from the 2021 National Survey of College Graduates. Weighted univariate and bivariate analyses were conducted to generate a descriptive profile of MSW graduates with respect to sociodemographic, education, and employment characteristics. Study findings can help employers, health services researchers, policymakers, and practitioners understand the context of the MSW workforce as it relates to diversity, labor workforce projection data, and student loan and salary considerations. This information can guide future policy and training goals to support the future vitality of the social work profession., (© 2024 National Association of Social Workers.)