Reference no: EM133381338
Social Needs Integration in the Current Healthcare System
The United States (U.S.) government's action to progressively increase its expenditure in healthcare over the years continues to elicit heated debates within political circles and among healthcare stakeholders (Hayajneh and Weltmann 690). Ideally, the high healthcare expenditure is intended to improve the quality of medical care that patients receive. However, the high costs involved with healthcare have failed to match the established levels of healthcare outcomes. For one, the U.S. continues to record lower life expectancy, increased infant mortality ratesand higher levels of obesity and chronic illnesses despite its expensive healthcare (691). The disjointed relationship between the current healthcare costs and outcomes is further exacerbatedby the successes of the healthcare systems of other developed countries that are not as expensiveyet lead to better health outcomes among their citizens (BravemanandGottlieb 20). In most instances the poor health outcomes cut across the different demographic groups regardless of age, gender and social status. In other instances that are more specific, there are dominant differences in the efficacy of healthcare services betweencertain groups and others. The disproportionate healthcare delivery in the nation pinpoints some of the social issues that researchers merit as restrictive to the attainment of improved and equitable healthcare (22). This paper reviews past studies on healthcare integration with the primary focus of understanding the significance of incorporating social needs in the current healthcare system. Subsequently, the article analyzes cases studies of states that have attempted to implement this type of healthcare integration, their considerations, successes and challenges.
Background
Studies that propose the need for the integration of patients' social needs with healthcare are quick to cite a high mortality rate that is not attributable to the current quality of clinical care in the U.S. Instead, such studies warn that there were "non-medical" factors that undermined the health-related behaviors of the population (Braveman and Gottlieb20). Different studies have established significant relationships between certain economic or sociocultural issues and people's vulnerabilities to ailments, and even their differentiated access to healthcare services (23). Dejectedly, because most of these social issues fall outside the scope of public health and medical experts, practitioners need to collaborate with social work agents to improve health outcomes.The argument about the importance of social needs advocacy in healthcare systems in the United States began to gain traction as more studies identified adverse social determinants of health (SDoH) as threats to healthcare outcomes (Braveman and Gottlieb, 2014; Hahn, 2021). Subsequent studies on the topic of integrating healthcare systems have been assertive of the need for caseworkers because of the advocacy roles they play in health systems (). Therefore, most evidence-based studies on healthcare outcomes in the United States propose a transformation of conventional health service delivery approaches. Such propositions involve the creation of healthcare systems that take into account "health-related socialrisk factors" (National Academies of Sciences 1). The systems should be built around addressing the social needs of the populace thereby improving healthcare outcomes in more equitable ways.
Integrated Healthcare Definition & Components
The integration of social care in any healthcare system is contingent on having appropriately trained staff, innovations in health information management technologies and great financing models (3).
Despite earlier studies proposing the importance of integrating social needs into healthcare systems, the first significant step to this end was made through a 2019 multi-stakeholder consensus study (National Academies of Sciences 2). The study was led by a committee of diverse stakeholders who whose mandate was identify the best approaches of reducing healthcare inequities and enhance health outcomes through social care integration (3). In its review of some of the successes of healthcare systems in the committee narrows down to the most crucial actions that would facilitateintegration of social care in the current public healthcare system. They include "awareness, adjustment, assistance, alignment, and advocacy"(34). With awareness, providers develop resourceful ways of identifying their patients' social risks. Adjustment involves the creation of patient-specific care models that address the challenges identified by the awareness component. For instance, clinical staff could recommend alternatives to in-contact visits if a patient complains they struggle to make the commute from their homes to hospital. Assistance entails connecting patients with the relevant caseworkers and social needs resources. With alignment, providers identify existing social care systems in the community and create synergies between them and healthcare systems for better health outcomes. Finally, advocacy involves the collaboration between providers and social organizations to develop policies that promote mobilization of resources to address people's social and healthcare needs.
The need for social care integration in health mainly stems from continuous research into social determinants of health as described below.
SOCIAL DETERMINANTS OF HEALTH (SoDH). Social determinants of health are defined as the "non-medical" factors, such as economic status, that have significant impact on healthcare and yet fall beyond the professional scope of the medical profession (Braveman and Gottlieb 34).Hahn further refines this definition of SoDH to include social components, and "societal resources and hazards" pertaining to health that when controlled by social systems result in different health outcomes across the population (1).The researcher also takes a different stance by disparaging the concept of "non-medical factors" (3). Hahn cites that hospitals and healthcare organizations are social systems, and as such can form part of SDoH factors (3). Initial studies that affirmed the importance of SoDH share the consensus that medical care on its own contributed very little to preventable deaths (Braveman and Gottlieb20). In their review of demographic staerstistics, the researchers establish that some social factors were significant enough to undermine the outcomes of quality medical care among the U.S. population (23). Such SoDH factors involve stratifications established by social systems such as class, race and gender. The factors are characterized by the withdrawal of certain rights and resources for individuals belonging to groups with inferior power. The importance of SDoHresearch stems from the need to understand how societal forces shape healthcare outcomes while at the same time promote inclusivity for all social groups in healthcare services delivery (5).
Further research also ensures that vulnerable social groups are identified so that healthcare services can be made more accessible to them and tailored to their needs. One study on the determinants of health in the U.S. establishes that the nation has one of the highest social inequities in healthcare delivery among developed nations (Singh et al. 159). The researchers
Social workers in Healthcare
Theories and Frameworks
Roles/Responsibilities
Expected Health Outcomes
Case Studies of Integrated Healthcare Programs relying on Social Workers
Challenges of Integrating Social Workers in Healthcare
Despite the numerous advantages of integrating social workers into healthcare systems, the approach has some challenges that may derail its implementation with conventional healthcare systems. The challenges involving the integration of social healthcare needs are apparent from two fronts, that is, during the concept's initiation phase into healthcare and during its implementation processes (National Academies of Sciences 138). The initiation phase may involve different challenges such as the absence of leadership support, hesitance among providers who may presume that it will involve more responsibilities, and logistical challenges in setting up the infrastructure for rolling out the program. The implementation phase may also involve challenges such as the development of efficient social needs screening and response tools, communication breakdown between clinical staff and community based organizations, and patients' failure to follow up on caseworker referrals (151).