Repositioning Social Work Into Population Health

The AJPH December 2017 supplement¹ focused on the important intersection between social work and public health. Indeed, both professions have been historically dedicated to the promotion of social justice and health equity. Although the authors addressed the applications of social work themes and values, they neglected to translate some of these agendas into social work practice and, in particular, to address the role of clinical social workers in population health models of care.

According to 2015 data from the Council on Social Work Education,² 79% of social work students specialized in direct, clinical, or generalist practice, many in health care settings. Only 21% of students specialized in “macro practice,” taking on roles implementing population-based health programs and policies.

So, where does clinical social work fit into this era of population health? Besides expanded insurance coverage, the Affordable Care Act ushered in the expansion of electronic health record infrastructures, which have been leveraged to deploy targeted, population-level interventions. This technology facilitates screening and linkage to care across a population rather than concentrating resources on high-risk individuals, offering more people less expensive care that reduces the overall burden of disease. Without funding for individualized services of social workers, innovative models of collaborative care have been developed to use unlicensed care coordinators in primary care settings.

The evidence-based collaborative care for depression management program applies a stepped-model of integrated behavioral health care. To maintain cost-effectiveness and scale, licensed social workers must take a step back and act as supervisors of unlicensed behavioral health care coordinators rather than providing direct care management. Social workers are not being replaced; they are being complemented. This stepped-care model promotes social justice and health equity, allowing care coordinators to implement basic interventions while clinical social workers may work in supervisory roles and provide more advanced interventions for sicker patients.

In their editorial, “Out of Our Comfort Zone to Improve Population Health: A Public Health of Consequence,” Galea and Vaughan³ attribute the growth and efficacy of population health paradigms to the seminal work of Sir Geoffrey Rose.⁴ We suggest that social work reposition its role in the health care landscape by instilling a population health methodology in its current practice, curricula, and training. This strategy aligns with the recommendations for social work education by Teri Browne et al.⁵ and may enable social workers to position themselves more successfully as leaders and to continue to pursue social justice in the health care arena.