Social workers are key to addressing social determinants of health in integrated care settings

References

• Adepoju, O. E., Preston, M. A., & Gonzales, G. (2015). Health care disparities in the post–Affordable Care Act era. American Journal of Public Health, 105(S5), S665–S667. https://doi.org/10.2105/AJPH.2015.302611
   PubMed Web of Science ®Google Scholar
• Adler, N. E., Cutler, D. M., Fielding, J. E., Galea, S., Glymour, M. M., Koh, H. K., & Satcher, D. (2016). Addressing social determinants of health and health disparities: A vital direction for health and health care. NAM Perspectives, 6(9). https://doi.org/10.31478/201609t
   Google Scholar
• Alvidrez, J., Castille, D., Laude Sharp, M., Rosario, A., & Tabor, D. (2019). The national institute on minority health and health disparities research framework. American Journal of Public Health, 109(S1), S16–S20. https://doi.org/10.2105/AJPH.2018.304883
   PubMed Web of Science ®Google Scholar
• American Psychiatric Association & Academy of Psychosomatic Medicine. (2016). Dissemination of integrated care within adult primary care settings: The collaborative care model. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Professional-Topics/Integrated-Care/APA-APM-Dissemination-Integrated-Care-Report.pdf
   Google Scholar
• Armitage, G. D., Suter, E., Oelke, N. D., & Adair, C. E. (2009). Health systems integration: State of the evidence. International Journal of Integrated Care, 9(2), e82. https://doi.org/10.5334/ijic.316
   PubMedGoogle Scholar
• Basu, S., & Narayanaswamy, R. (2019). A prediction model for uncontrolled type 2 diabetes mellitus incorporating area-level social determinants of health. Medical Care, 57(8), 592–600. https://doi.org/10.1097/MLR.0000000000001147
   PubMed Web of Science ®Google Scholar
• Billioux, A., Verlander, K., Anthony, S., & Alley, D. (2017). Standardized screening for health-related social needs in clinical settings: The accountable health communities screening tool. NAM Perspectives, 7(5), 1–9. https://doi.org/10.31478/201705b
   Google Scholar
• Blalock, D. V., Maciejewski, M. L., Zulman, D. M., Smith, V. A., Grubber, J., Rosland, A. M., Weidenbacher, H. J., Greene, L., Zullig, L. L., Whitson, H. E., Hastings, S. N., & Hung, A. (2021). Subgroups of high-risk VA patients based on social determinants of health predict risk of Future hospitalization. Medical Care, 59(5), 410. https://doi.org/10.1097/MLR.0000000000001526
   PubMed Web of Science ®Google Scholar
• Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It’s time to consider the causes of the causes. Public Health Reports, 129(1_suppl2), 19–31. https://doi.org/10.1177/00333549141291S206
   PubMed Web of Science ®Google Scholar
• Buchanan, G. J. R., Piehler, T., Berge, J., Hansen, A., & Stephens, K. A. (2022). Integrated behavioral health implementation patterns in primary care using the cross-model framework: A latent class analysis. Administration and Policy in Mental Health and Mental Health Services Research, 49(2), 312–325. https://doi.org/10.1007/s10488-021-01165-z
   PubMed Web of Science ®Google Scholar
• Caldwell, K., & Atwal, A. (2003). The problems of interprofessional healthcare practice in hospitals. British Journal of Nursing, 12(20), 1212–1218. https://doi.org/10.12968/bjon.2003.12.20.11844
   PubMedGoogle Scholar
• Centers for Disease Control and Prevention. (2022). Social Determinants of Health. https://www.cdc.gov/about/sdoh/index.html
   Google Scholar
• Centers for Medicare & Medicaid Services. (2023). Behavioral health integration services. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/BehavioralHealthIntegration.pdf
   Google Scholar
• Chen, D., Torstrick, A. M., Crupi, R., Schwartz, J. E., Frankel, I., & Brondolo, E. (2019). Reducing emergency department visits among older adults. Journal of Integrated Care, 27(1), 37–49. https://doi.org/10.1108/JICA-02-2018-0011
   Web of Science ®Google Scholar
• Cooper, Z., Reitmeier, M., & Bethel, S. R. (2022). Health professionals’ attitudes on integrated care and social work practice. Social Work in Health Care, 61(5), 369–386. https://doi.org/10.1080/00981389.2022.2104984
   PubMed Web of Science ®Google Scholar
• Cordova-Ramos, E. G., Kerr, S., Heeren, T., Drainoni, M. L., Garg, A., & Parker, M. G. (2022). National prevalence of social determinants of health screening among US neonatal care units. Hospital Pediatrics, 12(12), 1040–1047. https://doi.org/10.1542/hpeds.2022-006767
   PubMedGoogle Scholar
• Coster, S., Norman, I., Murrells, T., Kitchen, S., Meerabeau, E., Sooboodoo, E., & d’Avray, L. (2008). Interprofessional attitudes amongst undergraduate students in the health professions: A longitudinal questionnaire survey. International Journal of Nursing Studies, 45(11), 1667–1681.
   PubMed Web of Science ®Google Scholar
• Daniel, H., Bornstein, S. S., & Kane, G. C. (2018). Health and public policy committee of the American college of physicians. Addressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper Annals of Internal Medicine, 168(8), 577–578. https://doi.org/10.7326/M17-2441
   Google Scholar
• Davis, M. M., Gunn, R., Gowen, L. K., Miller, B. F., Green, L. A., & Cohen, D. J. (2018). A qualitative study of patient experiences of care in integrated behavioral health and primary care settings: More similar than different. Translational Behavioral Medicine, 8(5), 649–659. https://doi.org/10.1093/tbm/ibx001
   PubMed Web of Science ®Google Scholar
• de Saxe Zerden, L., Lombardi, B. M., Fraser, M. W., Jones, A., & Rico, Y. G. (2018). Social work: Integral to interprofessional education and integrated practice. Journal of Interprofessional Education & Practice, 10, 67–75. https://doi.org/10.1016/j.xjep.2017.12.011
   Google Scholar
• Ewald, B., Golden, R., & Mason, D. J. (2021). Promoting health equity by paying for social care. JAMA Health Forum, 2(12), e215023–e215023. https://doi.org/10.1001/jamahealthforum.2021.5023
   PubMedGoogle Scholar
• Feldman, S. S., Davlyatov, G., & Hall, A. G. (2020). Toward understanding the value of missing social determinants of health data in care transition planning. Applied Clinical Informatics, 11(4), 556–563. https://doi.org/10.1055/s-0040-1715650
   PubMed Web of Science ®Google Scholar
• Fraher, E. P., Richman, E. L., de Saxe Zerden, L., & Lombardi, B. (2018). Social work student and practitioner roles in integrated care settings. American Journal of Preventive Medicine, 54(6), S281–S289. https://doi.org/10.1016/j.amepre.2018.01.046
   PubMed Web of Science ®Google Scholar
• Fraser, M. W., Lombardi, B. M., Wu, S., de Saxe Zerden, L., Richman, E. L., & Fraher, E. P. (2018). Integrated primary care and social work: A systematic review. Journal of the Society for Social Work and Research, 9(2), 175–215. https://doi.org/10.1086/697567
   Web of Science ®Google Scholar
• Freeman, D. S., Manson, L., Howard, J., & Hornberger, J. (2018). Financing the primary care behavioral health model. Journal of Clinical Psychology in Medical Settings, 25(2), 197–209. https://doi.org/10.1007/s10880-017-9529-4
   PubMed Web of Science ®Google Scholar
• Garg, A., Boynton-Jarrett, R., & Dworkin, P. H. (2016). Avoiding the unintended consequences of screening for social determinants of health. JAMA, 316(8), 813–814. https://doi.org/10.1001/jama.2016.9282
   PubMed Web of Science ®Google Scholar
• Gottlieb, L., Tobey, R., Cantor, J., Hessler, D., & Adler, N. E. (2016). Integrating social and medical data to improve population health: Opportunities and barriers. Health Affairs, 35(11), 2116–2123. https://doi.org/10.1377/hlthaff.2016.0723
   Web of Science ®Google Scholar
• Gröne, O., Garcia-Barbero, M., & WHO European Office for Integrated Health Care Services. (2001). Integrated care: A position paper of the WHO European office for integrated health care services. International Journal of Integrated Care, 1(2), e21. https://doi.org/10.5334/ijic.28
   PubMedGoogle Scholar
• Heath, B., Wise Romero, P., & Reynolds, K. (2013). A review and proposed standard framework for levels of integrated healthcare. SAMHSA-HRSA Center for Integrated Health Solutions.
   Google Scholar
• Hensley, C., Joseph, A., Shah, S., & O’Dea, C. (2017). Addressing social determinants of health at a federally qualified health center. International Public Health Journal, 9(2), 189.
   Google Scholar
• Hudon, C., Dumont-Samson, O., Breton, M., Bourgueil, Y., Cohidon, C., Falcoff, H., Senn, N., Van Durme, T., Angrignon-Girouard, É., & Ouadfel, S. (2022). How to better integrate social determinants of health into primary healthcare: Various stakeholders’ perspectives. International Journal of Environmental Research and Public Health, 19(23), 15495. https://doi.org/10.3390/ijerph192315495
   PubMed Web of Science ®Google Scholar
• Hu, J., Wu, T., Damodaran, S., Tabb, K. M., Bauer, A., & Huang, H. (2020). The effectiveness of collaborative care on depression outcomes for racial/ethnic minority populations in primary care: A systematic review. Psychosomatics, 61(6), 632–644. https://doi.org/10.1016/j.psym.2020.03.007
   PubMed Web of Science ®Google Scholar
• Interprofessional Education Collaborative [IPEC]. (2023). IPEC core competencies for interprofessional collaborative practice: Version 3. https://www.ipecollaborative.org/ipec-core-competencies
   Google Scholar
• Kostelanetz, S., Pettapiece-Phillips, M., Weems, J., Spalding, T., Roumie, C., Wilkins, C. H., & Kripalani, S. (2022). Health care professionals’ perspectives on universal screening of social determinants of health: A mixed-methods study. Population Health Management, 25(3), 367–374. https://doi.org/10.1089/pop.2021.0176
   PubMed Web of Science ®Google Scholar
• Lagomasino, I. T., Dwight-Johnson, M., Green, J. M., Tang, L., Zhang, L., Duan, N., & Miranda, J. (2017). Effectiveness of collaborative care for depression in public-sector primary care clinics serving latinos. Psychiatric Services, 68(4), 353–359. https://doi.org/10.1176/appi.ps.201600187
   PubMed Web of Science ®Google Scholar
• Larsson, S., Clawson, J., Howard, R., Bunce, A., Sheppler, C. R., Hoopes, M., Krancari, M., Gottlieb, L. M., Bowen, M., Bava, J., Mossman, N., Yosuf, N., & Marino, M. (2023). Implementation support for a social risk screening and referral process in community health centers. NEJM Catalyst Innovations in Care Delivery, 4(4). https://catalyst.nejm.org/doi/full/10.1056/CAT.22.0332
   PubMedGoogle Scholar
• Leathard, A. (Ed.). (2004). Interprofessional collaboration: From policy to practice in health and social care. Routledge.
   Google Scholar
• Melville, J. L., Reed, S. D., Russo, J., Croicu, C. A., Ludman, E., LaRocco-Cockburn, A., & Katon, W. (2014). Improving care for depression in obstetrics and gynecology: A randomized controlled trial. Obstetrics and Gynecology, 123(6), 1237. https://doi.org/10.1097/AOG.0000000000000231
   PubMed Web of Science ®Google Scholar
• Meyer, D., Lerner, E., Phillips, A., & Zumwalt, K. (2020). Universal screening of social determinants of health at a large US academic medical center, 2018. American Journal of Public Health, 110(S2), S219–S221. https://doi.org/10.2105/AJPH.2020.305747
   PubMed Web of Science ®Google Scholar
• Milano, N., Petruzzi, L., Covington, E., Jones, B., & Findley, P. A. (2022). Social workers in integrated care beyond primary care: A scoping review. Translational Behavioral Medicine, 12(11), 1038–1048. https://doi.org/10.1093/tbm/ibac082
   PubMed Web of Science ®Google Scholar
• Mooss, A., Myatt, J., Goldman, J., & Alexander, J. A. (2022). Integrated care effectiveness for adults with co-occurring disorders. Journal of Integrated Care, 30(1), 42–51. https://doi.org/10.1108/JICA-05-2020-0024
   Web of Science ®Google Scholar
• National Association of Social Workers. (2023). Improving access to mental health act (S. 838/H.R. 1638): Issue brief. https://www.socialworkers.org/LinkClick.aspx?fileticket=wt9KAjyOBqA%3d&portalid=0
   Google Scholar
• Netting, F. E., & Williams, F. G. (1996). Case manager-physician collaboration: Implications for professional identity, roles, and relationships. Health & Social Work, 21(3), 216–224. https://doi.org/10.1093/hsw/21.3.216
   PubMed Web of Science ®Google Scholar
• Pecukonis, E. (2014). Interprofessional education: A theoretical orientation incorporating profession-centrism and social identity theory. The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics, 42 Suppl 2(S2), 60–64. https://doi.org/10.1111/jlme.12189
   PubMed Web of Science ®Google Scholar
• Peek, C. J., & The National Integration Academy Council. (2013). Lexicon for behavioral health and primary care integration: Concepts and definitions developed by expert consensus. Agency for Healthcare Research and Quality. http://integrationacademy.ahrq.gov/sites/default/files/Lexicon.pdf
   Google Scholar
• Reiter, J. T., Dobmeyer, A. C., & Hunter, C. L. (2018). The primary care behavioral health (PCBH) model: An overview and opera-tional definition. Journal of Clinical Psychology in Medical Settings, 25(2), 109–126. https://doi.org/10.1007/s10880-017-9531-x
   PubMed Web of Science ®Google Scholar
• Sandberg, S. F., Erikson, C., Owen, R., Vickery, K. D., Shimotsu, S. T., Linzer, M., Garrett, N. A., Johnsrud, K. A., Soderlund, D. M., & DeCubellis, J. (2014). Hennepin health: A safety-net accountable care organization for the expanded Medicaid population. Health Affairs, 33(11), 1975–1984. https://doi.org/10.1377/hlthaff.2014.0648
   Web of Science ®Google Scholar
• Schickedanz, A., Hamity, C., Rogers, A., Sharp, A. L., & Jackson, A. (2019). Clinician experiences and attitudes regarding screening for social determinants of health in a large integrated health system. Medical Care, 57(Suppl 6 2), S197. https://doi.org/10.1097/MLR.0000000000001051
   PubMed Web of Science ®Google Scholar
• Schwartz, B., Herrmann, L. E., Librizzi, J., Gayle, T., Waloff, K., Walsh, H., Rucker, A., Herrera, N., & Bhansali, P. (2020). Screening for social determinants of health in hospitalized children. Hospital Pediatrics, 10(1), 29–36. https://doi.org/10.1542/hpeds.2019-0092
   PubMedGoogle Scholar
• Sokol, R., Austin, A., Chandler, C., Byrum, E., Bousquette, J., Lancaster, C., Doss, G., Dotson, A., Urbaeva, V., Singichetti, B., Brevard, K., Wright, S. T., Lanier, P., & Shanahan, M. (2019). Screening children for social determinants of health: A systematic review. Pediatrics, 144(4), e20191622. https://doi.org/10.1542/peds.2019-1622
   PubMed Web of Science ®Google Scholar
• Solberg, L. I. (2016). Theory vs practice: Should primary care practice take on social determinants of health now? no. The Annals of Family Medicine, 14(2), 102–103. https://doi.org/10.1370/afm.1918
   PubMed Web of Science ®Google Scholar
• Sommers, B. D., McMurtry, C. L., Blendon, R. J., Benson, J. M., & Sayde, J. M. (2017). Beyond health insurance: Remaining disparities in US health care in the post‐ACA era. The Milbank Quarterly, 95(1), 43–69. https://doi.org/10.1111/1468-0009.12245
   PubMed Web of Science ®Google Scholar
• Talen, M. R., & Burke Valeras, A. (2013). Introduction and overview of integrated behavioral health in primary care. In M.R. Talen & A. Burke Valeras (Eds.) Integrated Behavioral Health in Primary Care: Evaluating the Evidence, Identifying the Essentials, (pp. 3–8). https://doi.org/10.1007/978-1-4614-6889-9
   Google Scholar
• Texas Health and Human Services Commission. (2020). Texas Medicaid provider procedures manual. Retrieved October 12, 2020, from https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/tmppm/pdf-chapters/2020/2020-10-october/2_Behavioral_Health.pdf
   Google Scholar
• Tong, S. T., Liaw, W. R., Kashiri, P. L., Pecsok, J., Rozman, J., Bazemore, A. W., & Krist, A. H. (2018). Clinician experiences with screening for social needs in primary care. Journal of the American Board of Family Medicine, 31(3), 351–363. https://doi.org/10.3122/jabfm.2018.03.170419
   PubMed Web of Science ®Google Scholar
• Unützer, J., Harbin, H., Schoenbaum, M., & Druss, B. G. (2013). The Collaborative Care Model: An Approach for Integrating Physical and Mental Health Care in Medicaid Health Homes. In Health Home: Information Resource Center(Issue May). Retrieved March 12, 2023, from https://www.chcs.org/media/HH_IRC_Collaborative_Care_Model__052113_2.pdf
   Google Scholar
• Vickery, K. D., Shippee, N. D., Menk, J., Owen, R., Vock, D. M., Bodurtha, P., Soderlund, D., Hayward, R. A., Davis, M. M., Connett, J., & Linzer, M. (2020). Integrated, accountable care for Medicaid expansion enrollees: A comparative evaluation of Hennepin health. Medical Care Research and Review, 77(1), 46–59. https://doi.org/10.1177/1077558718769481
   PubMed Web of Science ®Google Scholar
• Weir, R. C., Proser, M., Jester, M., Li, V., Hood-Ronick, C. M., & Gurewich, D. (2020). Collecting social determinants of health data in the clinical setting: Findings from national PRAPARE implementation. Journal of Health Care for the Poor and Underserved, 31(2), 1018–1035. https://doi.org/10.1353/hpu.2020.0075
   PubMed Web of Science ®Google Scholar
• Zerden, L. D., Cadet, T. J., Galambos, C., & Jones, B. (2021). Social work’s commitment and leadership to address social determinants of health and integrate social care into health care. Journal of Health & Human Services Administration, 43(3), 309–323. https://doi.org/10.37808/jhhsa.43.3.5
   Google Scholar
• Zerden, L., Lombardi, B. M., Jones, A., & Prentice, A. (2018). The role of social work in the opioid epidemic: Office-based opioid treatment programs. Social Work in Health Care, 58(3), 339–344. https://doi.org/10.1080/00981389.2019.1553934
   PubMed Web of Science ®Google Scholar
• Zonneveld, N., Driessen, N., Stüssgen, R. A. J., & Minkman, M. M. N. (2018). Values of integrated care: A systematic review. International Journal of Integrated Care, 18(4), 9. https://doi.org/10.5334/ijic.4172
   PubMedGoogle Scholar