Innovations in MSW Education and Training for Practice in Integrated Care Environments

This special issue was conceived in 2014 in response to President Barack Obama’s historic health care legislation called the Patient Protection and Affordable Care Act, mainly known as the ACA. The purpose of this special issue is to contribute to the knowledge base on the subject of curricular innovations taking place nationally to prepare MSW students to practice in integrated care environments, that is, in behavioral health and primary care settings.

Since passage of the ACA in 2014, many things have changed and others have not. The primary change is the new administration’s attempts to radically change the ACA. What did not change is the general population’s commitment to the ACA’s components, which resulted in a failure by the administration to repeal the ACA in late March 2017. The extent to which the ACA will remain as is or considerably change remains to be seen. Notwithstanding the attempts to repeal or modify the ACA, there is no question that the social work profession, including allied health professions, has embarked on numerous efforts to more comprehensively strengthen students’ ability to practice in an interprofessional environment.

This is a timely topic in light of the changes taking place in health and behavioral health care delivery; the increasing trend to provide integrated care, especially with at-risk, vulnerable populations; and the considerable amount of comorbid health and behavioral health problems affecting the population. The articles in this special issue contribute to the knowledge base concerning promising practices from social work programs nationwide whose administrators are engaging in innovative educational activities to prepare the next generation of social work practitioners in interprofessional settings.

The articles capture how faculty and social work programs are meeting the challenges of developing the core competencies needed for students to work effectively as members of integrated health teams. Behavioral health and physical health systems are rapidly changing, and this special issue presents articles that describe how programs across the country are addressing best teaching practices for educating social work students and the social work workforce. The articles emphasize research on teaching and training students and social work professionals in the new integrated health environment and on ways to enhance multidisciplinary and case-based learning for students and professionals. Many of these new approaches involve the use of different instructional technologies to maximize student learning.

All the articles describe different models to teach students about integrated health care. Each article provides an in-depth description of the contributors’ programs’ conceptual frameworks and the activities by which they educate and train students and social work professionals to work in integrated care placements. As these articles show, a fairly large amount of curricular variation exists among programs nationwide in the extent to which they rely on evidence-based interventions, use multidisciplinary teams, and completely restructure versus making smaller modifications to their curricula. All the articles include innovations in field instruction concerning integrated health care placements. They cover topics that range from the challenges in finding integrated care placements and developing collaborations to specific activities for students, some of which may vary as a function of the population they serve—children and youths, adults, older adults, and others—to ensure they have an opportunity to engage in integrated care. All the articles, in one form or another, focus on curricular activities developed specifically for underserved populations, such as people living in rural areas or in cities experiencing various social and economic challenges. Some articles may focus on competent practice with culturally, racially, and ethnically diverse populations or their intersections.

All the articles describe the implementation of interprofessional education (IPE) programs and provide considerable details about their classroom activities, new and required courses students take, or modifications to their curricula or field internships. Several describe innovative partnerships with allied professions, and some describe the innovative use of technological approaches. The article by Putney et al. titled “An Innovative Behavioral Health Workforce Initiative: Keeping Pace with an Emerging Model of Care” describes the Behavioral Health Workforce Initiative that includes components that draw from the Center for Integrated Health Solutions Standard Framework for Levels of Integrated Health Care. The article provides a detailed description of the program’s three main training components—specialized field placements, advanced clinical electives, and required cocurricular and interprofessional seminars—as well as the result of a process evaluation. The process evaluation was used to identify the extent to which the program implemented the activities as proposed and the extent to which students believed they were being prepared for work in integrated primary care settings, and to identify variations in degrees of integration across field settings. The next article, by Smith-Osborne and Daniel, titled “Concurrent Infusion of Integrated Behavioral Health Practice into Social Work Field and Classroom Instruction” describes a school of social work’s initial efforts to infuse integrated behavioral health content concurrently into field and classroom instruction. The evaluation of this program involved the extraction of qualitative data from de-identified transcripts of students’ comments on Web-based learning platforms, administrative data sets, and classroom observations. Their evaluation results point to a number of key elements that interprofessional education programs should pay attention to. The article by Rishel and Hartnett titled “Meeting the Challenge of Preparing Social Workers for Integrated Health Practice: Evidence from Two MSW Cohorts” describes the development, implementation, and evaluation of their Integrated Mental and Behavioral Health Training Program. As stated by these contributors, their program not only sought to develop highly skilled practitioners to provide behavioral health services in integrated care settings but also to develop leaders in rural integrated health service delivery. Two unique aspects of their evaluation are the 1-year postgraduation follow-up and employment outcomes data.

The article by Lapidos and Ruffolo titled “Access to Interprofessional Continuing Education in Integrated Care through Digital Instructional Technology” provides a detailed description of the structure, content, digital approach, and outcomes of a continuing education program in integrated behavioral health and primary care. In this article, Lapidos and Ruffolo argue that the traditional brick-and-mortar classroom approach is insufficient to educate most professionals in need of integrated care education. To address this concern, they developed and evaluated a continuing education program in integrated behavioral health and primary care that consisted of a fully Web-based experience with synchronous and asynchronous components. Their article describes the evaluation they conducted that highlights their successes and challenges. The article by Craig et al. titled “Enhancing Competence in Health Social Work Education Through Simulation-Based Learning: Strategies From a Case Study of a Family Session” describes the development and implementation of a simulation-based learning approach to prepare students to practice in integrated health settings. They conclude the article with a number of very helpful and detailed step-by-step recommendations for using simulation-based learning to train students.

The articles by Zerden et al., “Infusing Integrated Behavioral Health in an MSW Program: Curricula, Field, and Interprofessional Educational Activities;” Mattison et al., “Educating Social Workers for Practice in Integrated Health Care: A Model Implemented in a Graduate Social Work Program;” and Wharton and Burg, “A Mixed-Method Evaluation of Social Work Learning Outcomes in Interprofessional Training with Medicine and Pharmacy Students” provide detailed descriptions of programs that included professionals in several health disciplines actively involved in the development and implementation of collaborative educational programs. These contributors describe how instructors in their programs developed and cotaught courses in conjunction with instructors of other professional schools such as medicine, nursing, public health, dentistry, pharmacy, and kinesiology. These articles describe important challenges and successes the contributors experienced with implementing and evaluating these unique programs.

In conclusion, as these studies show, there is considerable variation in the ways administrators of schools of social work have conceptualized, developed, implemented, and evaluated interprofessional training programs. From the various evaluations conducted, many important themes emerge, but the two we want to highlight here concern the challenge students experienced with their roles in interprofessional teams despite all the training, activities, and instructors’ efforts. The second theme to emerge is the appreciation for the social worker’s lens in assessing a health care problem that emerged among professionals in other disciplines such as medicine or pharmacy, who over time acquired a more nuanced understanding and appreciation of social work’s contribution to the interprofessional team.

In February 2016, the Council on Social Work Education joined the IPEC with several other allied health professions. This collaborative has developed four core competencies that are critical to meeting the triple aims of the ACA (improving the experience of care, improving the health of populations, and reducing the per capita cost of health care; IPEC, 2016). The IPEC identified the following four core competencies to address the triple aims: working with individuals of other professions to maintain a climate of mutual respect and shared values; using the knowledge of one’s own role and those of other professions to appropriately assess and address the health care needs of patients and to promote and advance the health of populations; communicating with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease; and applying relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient and population–centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable (IPEC, 2016, p. 10).

Future research in social work education needs to address how well schools of social work are doing in collaborating with other allied health professions in developing these cross-disciplinary, interprofessional competencies within their programs. Many of the articles in this special issue capture initial efforts to operationalize these core competencies in social work course work and field placements. The key for social work education is not only to focus on educating future social workers for interprofessional collaborations but also to update the skills of the current social work workforce to effectively provide leadership and supervision of students in this changing health care environment. Social work educators need to rigorously evaluate the effectiveness of these new courses, field opportunities, and cross-discipline collaborations in demonstrating the four core competencies. Are these educational changes in the training of social work students making a difference in patient-centered care and in the development of effective collaborations and teamwork in health care settings? Research and evaluation of these new educational initiatives and interprofessional collaborations involve engaging with other allied health educators to determine how well these efforts are changing the experiences of students and the experiences of patients or consumers. It is important to use a range of research and evaluation approaches to measure change including more mixed-methods approaches, pre- and postmeasures not only of student assessments but also from the perspectives of other professionals and patients or consumers, and more in-depth study of how these interprofessional courses function and of collaborations that work or do not. Sustaining these new initiatives in schools of social work is another area that needs further study. Evaluation of these initiatives involves examining the critical elements that must be in graduate and undergraduate social work education programs related to interprofessional education and how schools ensure that core training elements are not lost over time (e.g., coteaching courses with professionals from other disciplines, having students from different disciplines in the same courses, providing additional supervision and support to the workforce). Having the Council on Social Work Education as a partner in the IPEC collaborative is critical to ensuring that the voice and contribution of social workers and social work education is not lost in this ever changing health care landscape.