The Role of Social Work

in Integrated Health
Module 2
Judith Anne DeBonis PhD
Department of Social Work
California State University Northridge
Module 2
The Role of Social Work in Integrated
Health
By the end of this module students will:
 Understand the changing role of social work in healthcare
 Recognize the importance of clearly communicating the social
work role as it relates to IH
 Practice skills necessary to work as an effective team
member
 Realize the value of their personal leadership qualities in IH
 Be aware of the positive impact of practice and policy
advocacy actions on IH
 Learn how emotional intelligence and relational leadership
can support the need for collaboration in IH
 Identify special issues related to ethical standards apply to IH
Definitions, Primary Care Teams,
Functions and Benefits
Significant Shifts and Changes in
Healthcare
 Changes in healthcare have impacted the role and
responsibilities of both providers and patients. These changes
have also resulted in a call for “new roles,” “new models of
treatment,” and “new professional competencies and training”1
 For example—increases in the number of patients who have
chronic health conditions requires a different model of
treatment and more collaboration between patients and
providers.2
Social Work has been interested in
chronic care for close to 100 years 3
Historical Role of Social Work in Healthcare
 As early as 1915, medical social work was defined as a specific
form of social case work focused on the relationship between
disease and social maladjustment.3
 With an emphasis on the social impediments to health, social
workers were charged with “providing some occupation or
experience for the person jolted out of his regular plan of life by
chronic disease, to offset what he has lost and to make him
feel that he has still a useful place in the world.”3
“It is an important part of the social worker’s
Do
Do these
these concepts
concepts function to concern herself with the social
apply
apply to
to social
social work
work problems arising directly out of the nature of
and
and healthcare
healthcare today?
today? the medical treatment.”
Harriet Bartlett 3
Current Role of Social Work in Healthcare
 Little consensus in the literature as to the role of social work in
healthcare
 A wide variety of descriptions reflecting a range of
responsibilities and functions. Including broad conceptual roles
such as the promotion of equality of opportunity, the
advancement of social change, and the task of challenging
injustice4
Responding to the call for increasing accountability, application of evidence-
based practices, and cost effectiveness, there is movement in Social Work:
1. Shift to adapt and integrate as behavioral health specialists in primary care settings
2. Shift to community-based treatment models implementing evidence-based practices
which serve consumers in a cost effective manner, while providing more
comprehensive and integrative quality of care. 5
3. Shift to expand Social Work to include research as an important aspect of the social
work role. 5,6
Then:
Social Work Looked to Medicine as the Model Profession

Medical Social Work did not meet the criteria for a

profession:
 Social Work had a “professional spirit” but members did not
have sufficient individual responsibility, lacked a written body
of knowledge and educationally communicable techniques” 3
 Initially social work viewed medicine as a model profession
and an intrapersonal approach as more professional than one
focused on social and environmental factors3
Now:
Medical Professionals Look to Social Work to Guide Training
Tenets and principles of social work are being incorporated into the
competencies and training of other healthcare providers—physicians,
residents, nurses. Several examples: 7
 Well-trained residents/physicians are those who further the quality of care and
the humanistic mission of the medical profession. Residents are required to
be:
– Ethical, compassionate, effective at creating therapeutic relationships with patients
– Able to educate and empower, providing useful information to patients and families 8

– Skilled at working collaboratively with interdisciplinary healthcare teams

 A shift in attitude toward the relationship between physician and patient-
stressing collaboration, the importance of positive interactions, and the role that
all contributing parties serve in meeting the patient’s goals. 1
– Interpersonal Communication
– Process Vs. Outcomes
– Systems Based Practice 7
What Social Work Tenets and Principles
Contribute to Integrated Health
 Includes a wide range of settings, organizations, populations where social
workers practice.
 Focuses on a broad range of health, mental health, as well as the social and
economic aspects of the lives of individuals, groups and communities 9
– Has lead to a health paradigm that more readily acknowledges a range of
psychosocial contributions to the etiology, course and outcome of illness. 10
 Importance of a therapeutic relationship
 Collaboration
 Communication skills Social work’s value to healthcare delivery remains
 Resilience its comprehensive view of social and psychological
 Advocacy circumstances as they interact with health and
 illness, and its flexible range of helping
Justice 7
interventions to deal with the personal,
 Client Empowerment interpersonal, and environmental barriers. 10
 Self-Determination
Role of Social Work in Primary Care
Defining Primary Care – the
provision of collaborative,
accessible healthcare services
by clinicians who are
accountable for
 addressing a large majority of
personal healthcare needs
 developing a sustained
partnership with patients
 practicing from a
biopsychosocial systems
perspective in the content of
family and community 7
Primary Care
 Refers to Family Medicine,
pediatrics, geriatrics, internal
medicine…not specialty care
 Often the first line of entry to the
healthcare system for patients—
their medical home
Role of Social Workers in PC
 Prevention
 Health Promotion
 Service Delivery Design
 Acute and Chronic Care
 Treatment
 Rehabilitation
 Long-Term Care 12
Specific Functions:
A day in the life of social workers in…
Primary Care
 Behavioral health practices must be adapted to
adhere to the fast pace of a primary care setting
 See patients for 15-30 minutes to conduct a
focused assessment and to develop a treatment
plan. This information is then discussed with the
Primary Health Provider (PHP) and details a
behavioral health change plan.
 Implement, monitor, or change the intervention,
using one to four 15-30 minute appointments.
 Use the 5 A’s
– Assess- Gather information on symptoms,
emotions, thoughts, and behaviors
– Advise – Describe treatment options to patients
– Agree- Patients decide on their course of action
– Assist- Help patients learn new information,
develop new skills, solve problems, and
overcome barriers
– Arrange- Specify when the patient will follow-up
with the provider.13
Behavioral Health
 Discuss medication side effects with
patients, remind patients of skills used to
reduce anxiety
 Arrangement for patients for AA Groups,
Anger Management Groups, etc.
 Meet with patients during crisis situations,
determining suicidality (and need for
referral to community services for those
patients who are already reintegrated back
into their communities.
 Referrals, where applicable, for patients
needing psychiatric services
 One on one and group therapy sessions
 Charting
 Sit in with presentations on issues relating
to patient care (medications, nutrition)
 Attention to self-care 14
Group Activity
Using the 5A and 5R Brief Intervention Models
Combining the 5 A’s with the 5 R’s:
 Use the 5 A’s (Assess, Advise,
Agree, Assist, and Arrange) when
the person is ready and willing to
make a change.
 Use the 5 R’s (Relevance, Risks,
Rewards, Roadblocks, Repetition) to
educate and motivate a person who
is not ready to make a change
Using Brief Interventions:
Highlights how essential health
behaviors are to overall health
Helps identify when a person is
ready to make a change so that
appropriate assistance can be
offered
Offers an opportunity to check on
health behavior “vitals” during
every visit

Using
Using the
the 5A
5A and
and 5R
5R Handout
Handout the
the group
group will
will role
role play
play and
and practice
practice how
how they
they
would
would assess
assess aa person’s
person’s health
health behavior
behavior “vitals”
“vitals” and
and apply
apply the
the As
As and
and RsRs
from
from the
the models.
models. Debrief
Debrief to
to see
see what
what works
works and
and where
where more
more practice
practice is
is
needed.
needed.
How can Social Workers Function
Effectively in an Interdisciplinary
Healthcare
Skills Team? Characteristics
Knowledge in:
 Medical Literacy
 Consultation Liaison skills
with medical problems
 Population Screening
 Chronic Disease Management
 Care Management Skills
 Educating medical staff about
integrated care
 Evidence-Based Interventions
 Group Interventions
 Working within the fast-paced,
action-oriented ecology of
primary care 15
Ability to be:
 Responsive
 Committed to social justice
 Commitment to the ethical practice
of social work
 Commitment to social change
 Functional independently and
collectively with others
 Sensitive to relationships
 Interact positively and
instructively with clients 16
Group Activity
Building Skills for Effective Interdisciplinary
Practice
Skills
Knowledge in:
 Medical Literacy
 Consultation Liaison skills
with medical problems
 Population Screening
 Chronic Disease Management
 Care Management Skills
 Educating medical staff about
integrated care
 Evidence-Based Interventions
 Group Interventions
 Working within the fast-paced,
action-oriented ecology of
primary care 15
Put Skills and Knowledge into Action
Have students identify and briefly share their
knowledge on one of the skill topics listed
Discuss as a group how that skill might be applied
to different practice settings and clinical
scenarios
Role play an interaction related to the skill
highlighting the social work Characteristics that
were observed (from the previous slide)
Example: A student is working to increase their
knowledge about diabetes as a chronic
condition. The role play might offer a chance for
the student to discuss with a patient who has
been managing diabetes for many years, the
challenges and stress of the daily care
necessary to keep the condition under good
control.
Social Workers as Leaders
*Note: There are multiple leadership models. Blanchard (2009) model was
chosen because it applies to leadership for individuals as well as self-leadership.
Defining Leaders and Leadership

? When you
think of leaders,
who comes to
mind?
“Famous” Leaders
Presidents, patriots, world leaders, inventors, explorers, educators, authors,
religious leaders, activists

Abraham Lincoln
Mahatma Gandhi
Dalai Lama
Mother Teresa
Rev. Martin Luther King, Jr.
Walt Disney
Bill Gates Rosa Parks
“Everyday” Leaders
Not as visible or famous but may have enormous impact and be responsible for
incredible change

Parents
Teachers
Neighbors

Boy Scout Leaders

Veterans
Team Coach
Group Activity
Qualities of Leaders
Instructions
 The goal is to record some of your personal strengths as a
leader.
 Think about:
– People who acted as leaders in your life
– A time or situation when you acted as a leader
 Identify the leadership qualities that you exhibited and posses.
Are these qualities also present in the people you identify as
leaders?
The Good News

All leaders have a

No one is born a cause that motivates
leader… but leadership them to act. Leaders
capacity and qualities will sacrifice and
can be developed 17 persevere to achieve
their vision.
What qualities do all leaders have?

“A great leader is a person who

listens, and asks the kinds of
questions that gives those around
him or her a chance to be heard.”
17
The Serve Model 17

See the future Envision a picture of the preferred future

Engage and develop others Invested in a cause, and inspire

others to collaborate toward success

Reinvent continuously Lifelong learners who put

new information to good use

Value results and relationships Progress and success can be

measured in outcomes and
partnerships

Embody the values Talking the talk and walking the

walk
Connecting Leadership Capacity
to Health
Using Leadership to Enhance Health 18

Developing self-leadership skills

As self-leaders, we’re can help individuals to
able to draw on our participate more fully in a
“partnership” with healthcare
leadership qualities to providers.
increase our feeling of Patients who are self-leaders will
competence and self- experience an “internal”
determination which can satisfaction with decision
making and taking actions that
maximize our health. enhance their health.
Group Activity
Identifying Leadership Qualities in Patients
Think about a patient that you’ve met and talked with
recently.
 What leadership qualities did that person possess?
 How were each observed?
 Was the quality included as part of the discussion?
 How could that one quality be used by the patient to enhance
their health?
Consider how you would incorporate this information into
your next visit with the patient.
Serve Model 17

Revisited and Applied to Self-Leadership

Self-Leaders How Am I Doing?
 Know the changes they want  Can I describe what it would
to make look like when the change is
made?
 Are optimistic that change is
possible  Am I recognizing what I’m
already doing, no matter how
 Identify steps to take toward
small, toward achieving that
those goals
goal?

S ee the future Envision a picture of the preferred future

SERVE
WHAT WE KNOW 19
 Believing that change is possible is essential
 Investing in details about the change is more likely to lead to
desired results
 When practiced consistently, small changes have a big impact
 Self-Leaders
 Aware of when they’re fully
engaged
 Focus on goals that they care
about
 Identify strengths that serve
to accomplish the goal
How Am I Doing?
 Is the goal I set for myself
something that I want, or
what others want for me?
 Does achieving the goal
engage me?
 Do I have the skills and
support necessary to take
action?

E ngage and develop others

Invested in a cause, and inspire
others to collaborate toward success
SERVE
WHAT WE KNOW 20
 Having a positive and respectful self-relationship serves as the
foundation for change and helps to sustain the process.
 Potential rewards for change efforts provides the motivation
needed to take action.
 Self-Leaders
 Approach change as a
learner
 Allow for experimentation
 Adapt and customize
 Know what works for them
How Am I Doing?
 Do I take the time to explore?
 Do I have the information I
need?
 What past accomplishments
can I use or apply?
 Can I translate failures into
opportunities?

R einvent continuously
Lifelong learners who put new
information to good use
SERVE
WHAT WE KNOW 20,21
 Taking time to discover means that the plan has better
potential for success.
 If a strategy or an approach works, do more of it.
 If a strategy is not working, try something different.
 Exceptions to problems exist, and if identified, lead to a path of
change.
 Self-Leaders How Am I Doing?
 Take pride in  Do I acknowledge small
accomplishments steps toward goals?
 Have a sense of self-  Have I set up rewards that
acceptance keep me motivated?
 Value both personal choices  Do I give myself credit for
and partnerships to direct hard work and effort
their life course required?

V
Progress and success can be
alue results and relationships measured in outcomes and
partnerships
SERVE
WHAT WE KNOW 22
 Sustaining change requires reinforcement and ongoing
motivation.
 Reviewing goals that were accomplished reinforces the
actions that need to continue to sustain it.
 The way that one change is accomplished can be applied to
other changes.
 Social support networks provide multiple benefits in the
change process.
 Self-Leaders
 Have clear sense of values
 Aware of how daily actions
reflect values
 Recognize that there are
numerous ways to enhance
health and vitality
How Am I Doing?
 How does my process of
making changes toward
health serve others around
me?
 Do I share my experiences in
the change process to help
others?

E mbody the values

Talking the talk and walking
the walk
SERVE
WHAT WE (MAYBE) KNOW
 There are multiple options to show that we value our health.
 We can decide to participate at any time.
 If we commit to the value of optimal health, how we go about
living that value is up to us.
 Relying on our leadership qualities is our own best asset to
change.
Group Activity
Applying the SERVE Model to Integrated
Health
What opportunities do each of the 5 aspects of the SERVE
model offer to the patient and the social work provider?
Consider the following case example: A 48 year old Latina woman was referred to
the behavioral health specialist by the PCP. The patient was diagnosed with Type 2
diabetes 3 years ago and prescribed oral medication and lifestyle changes. She
states that she hopes she will be able to lose weight and not need the medications
anymore but the report from the PCP indicates that her recent HbA1C indicates
that her condition is not well-managed. She is the primary cook for her husband,
and two children (ages10 and 12) and doesn't want to cook any special meals. She
says she tries to "cook healthy food and not too many sweets" but sometimes just
skips meals to help lose weight. She has also started an exercise program, walking
about 30 minutes at least 3 times each week. Patient was treated briefly for
depression after the death of her Mother from a sudden heart attack last year but
currently is not taking medication for depression or seeing her counselor.
Group Activity
Understanding Why People Follow 23

Instructions from a Gallop Poll

What leader has Now please list 3

the most positive words that best
describe what this
influence in your person contributes
daily life? to your life.
How Did 10,000 People Respond? 23

 In some cases over 1,000 people had listed the exact same
words even though no categories or options were provided
 Followers have a very clear picture of what they want and need
from the most influential leaders in their lives
They Need...
 Trust
 Compassion
 Stability
 Hope

Given that there are more than 170,000 words in the English language, this was impressive!
Taking an idealistic
vision can be much
harder work but the
payoffs are enormous

Do
Do these
these concepts
concepts
apply
apply to
to social
social work
work
and
and healthcare
healthcare today?
today?
Social Workers as Advocates
The Need for Advocacy
Jansson (2011) reports that patient care can be compromised by seven
common problems that often go unaddressed when healthcare consumers
and providers do not effectively engage in advocacy. 24
Both healthcare professionals and consumers must
engage in advocacy to increase the odds that
consumers will receive:
(1) funding for care,
(2) quality care based on acceptable guidelines,
(3) protection of their ethical rights,
(4) culturally competent services,
(5) access to services in their community,
(6) preventive services, and
(7) attention to their mental health needs.
A Call to Action
Patient advocates are needed to protect and support healthcare consumers
Advocates must be
willing to speak on
behalf of the patient,
act as their
representative, and
coach the patient and
the family to advocate
on their own behalf 25
Social work professionals are in a
strategic position to become leaders in
promoting the role of patient advocate:
 by the nature of their values, their
commitment to social justice
 their ability to effectively
communicate and engage individuals
representing diverse backgrounds
 their application of the “person in
environment” or psychosocial
perspective 25,26
Taking Action to Protect and Assist Patients

Social Workers serving as: Regularly take advocacy actions:

 Care Managers
 Medical Social Worker
 Navigator or Health Coach
 Discharge Planner
 Expedite referrals, gather
consumer information, help obtain
second opinions, mediate between
care providers, educate consumers
on self-care management, link to
inpatient and outpatient services.
Using Influence for Successful
Social Work Advocacy 24
Influence in Interpersonal Exchanges. Advocates can exert
influence by drawing upon the following interpersonal experience:
 Expertise: Tactfully display personal knowledge, credentials, and suggest
evidence-based practices
 Coercion: Cite adverse implications for consumer dissatisfaction, potential
reputational losses
 Rewards: Praise physician for helping a consumer and promise to go the
“extra mile” in the future
 Charisma: Become admired for “putting patients first” or being a “team
player” by displaying qualities of leadership, moral authority to motivate
others to follow
 Authority: Hold leadership positions in departments or persuade
administrators to serve as intermediaries
Successful Strategies for
Social Work Advocacy Engagement 24

Using Medical Culture

 Portray advocacy as coming from concern about consumer’s well-being
 Present concern from a medical ethics perspective to promote multi-
professional collaboration
 Engage physician, “I bring this case to your attention so that we can provide the
best services possible”
Employing Power-Dependence
 Social worker is viewed as credible when others depend on expertise
 Assume multiple functions beyond job description to enhance dependence
Taking Initiative and Responsibility
 Initiate improvements in consumers’ health care and follow through with action
 Participate in in-service training sessions, rounds, case findings, contribute to
medical records
Successful Strategies for
Social Work Advocacy Engagement 24

Develop Positive Track Record

 Positive reputation demonstrates competency and trustworthiness.

Appropriate Assertiveness
 Assert influence that will not compromise ability to engage in future advocacy.

Design Communication Strategy

 Communicate skillfully with various audiences in different situations.
 Consider audience and alter approach appropriately:
– Physician/Administrator- Provide options and ask for preference.
– Hostile audience- Create commonalities

Encourage Consumer Empowerment

 Guide consumer confidence by informing of rights and encourage self-
advocacy.
Group Activity
Excessive Fatalism as a Barrier to Advocacy
Jansson (2011) has described that “excessive fatalism” can impede a social
worker’s involvement in advocacy by “undercutting the belief that change is
possible.” 24
You are a newly graduated MSW and the only social worker working in a primary care setting
with 3 PCPs, 2 medical residents and 3 nurses. You have considerable experience and
interest in health, mental health and substance use problems. The program director
intimidates you and after your first team meeting, where you did not offer any input about
issues that concerned you, you decided that any of your ideas would not be valued by the
group and the only way to keep your job was to be compliant with the medical staff who
appear to have all of the power. While you initially believed that your social work
perspective would complement the medical services offered at the agency, you do not feel
that it is possible to change the agency structure or policies and therefore have become
more apathetic that the system can work to benefit what you observe as client needs.
Comment on this case based on your thoughts about the social work role in Integrated Health.
What strategies recommended by Jansson could be used to combat fatalistic thinking? Given
a scenario that you believe might lead you to feel powerless and hopeless, what resources,
knowledge, and personal capacities do you have that could assist you? In what ways does
fatalistic thinking impact providers, patients, families, agencies?
Social Workers as Collaborators
Importance of Relational Leadership in
Collaboration 28
Relational leadership is dispersed throughout an organization,
focusing on process rather than individuals.
 For IH, this type of leadership is essential to creating successful
settings and relationships:
 IH offers exciting possibilities for healthcare—as an evolving model,
there is no preexisting formula for how IH should operate
 IH organizations are likely to prioritize “learning” and generating
knowledge about the best ways to function
 Simultaneously, IH models will require significant change for all
stakeholders—patients, providers, payors
Relational Leadership Mirrors the Spirit of
Care Prescribed by IH 27
 Both consider the partnership/relationship essential to success
– Patient and Provider
– Provider and other providers (multidisciplinary team)
– All with the community

 Movement beyond traditional top management leaders and

compliance of followers, the power structure is inclusive

Can
Can traditional
traditional
primary
primary care
care embrace
embrace
this
this paradigm?
paradigm?
An Italian Feasibility Study Offers Hopeful
Evidence about Collaboration 29
Project Leonardo Patient Satisfaction Surveys
Tested the feasibility of including nurse
“My Care Manager and my
“care managers” trained in an
GP work together to help me,”
empowerment self management model into
the primary care/family practice setting to
support patients with chronic conditions “My Care Manager tells my
Historically Doctors worked as single Doctor about the things I
practitioners in their office without a nurse need”

Physicians reported: Care Managers:

Care Managers as the “ambassadors” of the
Care Managers (96%) felt
project, collaborating with the community
comfortable working in the GP
and “angels” supporting the patients to
office and Doctors
achieve better health
85% “My communication and relationship
with the patient was improved”
78% Satisfaction that “the quality of my time
with the patient was improved”
Defining Collaboration 27

 “Collaboration is a process of social interaction which has it’s

foundation that each individual is responsible for the group’s success
and achievement of a common goal”
 With collaboration, new opportunities to achieve extraordinary
outcomes become possible
 For IH, the goal of collaboration is to provide the most clinically
effective care to patients at the most efficient cost possible
 While IH settings will vary with the amount of collaboration, ideally as
collaboration increases, shared decision making would also increase

To foster collaboration relational leaders use Emotional Intelligence (EI)

Emotional Intelligence (EI) as the Key to
Collaboration 27
Social Worker training reflects clinical practice skills which are
essential to effective collaboration and emotional intelligence
Two Areas of Competence Related to Emotional Intelligence:
ONE TWO
Personal Competence Social Competence
1. Self Awareness 3. Social Awareness
Understand/manage emotions Empathy, sensitivity to verbal
self confidence and non verbal cues,
2. Self Management keen sense of others
Adaptive, optimistic, manage 4. Relationship Management
response to conflict Persuasion, conflict
management,
collaboration
Group Activity
Emotional Intelligence
Discussion Questions:
Development and mastery of 4 domains of emotional intelligence
related to personal competence (self awareness and self
management) and social competence (social awareness and
relationship management) can contribute to your ability to
effectively collaborate as a social worker.

1. Considering the 4 domains of EI, in which one are you

strongest?
– State how you developed that strength. How might you leverage this
strength in an IH environment to enhance your collaboration with the
PCP?
2. What is your weakest EI domain? How can you develop
additional dimensions in this area?
Social Workers as Promoters
of Ethical Practices
Ethical Standards for Integrated Health
Integrating different but complementary ethical standards is an expected
challenge for Integrated Health settings and providers:

 While the various professional disciplines

5 ethical issues of particular
represented in Integrated Health do not
importance to integrated health
share one set of ethical codes, most share
a common purpose – to protect both  Informed consent
healthcare consumers and providers 28  Confidentiality
 In the spirit of collaboration, “professional  Relationships with patients
pride” should yield to opportunities to
focus on the complexity of heath conditions  Relationships with colleagues
and the need for collaboration by  Scope of practice
practitioners to improve patient care and
provider satisfaction 28
Informed Consent 28
Medical /PCP Definition
 Part of the registration protocol,
patients give one consent for all care
 Necessary for the provision of any
healthcare treatment
Integration Issues
 The streamlined medical consent may
not be adequate for the BHP.
 Careful consideration and respect for
differing consent needs.
Social Work /BHP Definition
 An important part of the therapeutic
relationship; related to the patient’s
self-determination about their
treatment
Try out your skill…
 Practice how you would explain to the
patient your role and find out whether
they understand about their right to
understand the treatment options and
freely choose to participate..
Confidentiality 28
Medical /PCP Definition
 How much and what type of
information to be shared with whom?
 Some information can be treated with
different levels of privacy on a “need to
know basis” (keep certain information
from non-provider staff) or just
between the PCP and BHP (separate
notes protected from being released as
part of the general medical record)
Integration Issues
 Patient must be informed as to the
nature of the relationship between
PCP and BHP as well as with other
IH team members, how information
is shared
Social Work /BHP Definition
 Able to let patient know that there are
options to keep some discussions
completely confidential (BHP/patient)
 Need to review exceptions to
confidentiality regarding danger to self,
others, homicidal or suicidal ideation or
intent, child abuse reporting.
Try out your skill…
 Consider what you would say to a
patient who wants you to keep in
confidence information that they
have been using an illegal drug
Relationships with Patients 28
Medical /PCP Definition
 Protection of the patient/provider
relationship. Based on trust that the PCP
holds the patient welfare above his/her
self interests and will advocate for their
health needs
Integration Issues
 Both put patient needs first
 Less formal restrictions for PCPs who may
choose to treat relatives or co-workers
(multiple relationships permitted for PCP)
 BHPs can model a different way to think
about the patient/providers relationship
Social Work /BHP Definition
 The therapeutic relationship is built on
trust and respect; social workers should
not engage in dual or multiple
relationships with clients or former clients
in which there is a risk of exploitation or
potential harm to the patient
Try out your skill…
 Practice what you would share with your
patient as to why you would not initiate
conversation with them if you saw them in
public
Relationships with Colleagues 28
Medical /PCP Definition
 May work in collaboration with other allied
health professionals and hire them if they
are appropriately trained and licensed
Integration Issues
 There are ideological differences (PCPs
trained as leaders /decision makers
whereas BHPs trained as facilitators
/consensus builders)
 May pose some need for discussion so
both are comfortable
Social Work /BHP Definition
 Respectful of colleagues and avoid
unwarranted negative criticism of them in
communication with patients and other
professionals
Try out your skill…
 What strategies could a BHP take to
address their discomfort regarding power
differential in primary care
 What actions might a BHP take to build a
collaborative relationships with colleagues
Scope of Practice 28
Medical /PCP Definition
 Patient/Physician relationship is contractual
---both are free to enter or decline the
relationship
Integration Issues
 BHPs may be asked to perform duties that
they see as outside their area of expertise
(physical symptom or medication
management)
 IH must address special concerns regarding
the level of psychiatric care which can be
managed in a primary care setting (including
a collaboration with psychiatric specialist)
 Both PCP and BHP can learn from the
expertise of the other which will result in
better integration of patient care
Social Work /BHP Definition
 Social worker should provide services and
present themselves as competent only within
the boundary of their education, licensure,
relevant professional experience
Try out your skill…
 What are the advantages and disadvantages
of treating patients with mental health or
substance use disorders in primary care?
What issues might be better served in
specialty care? What safeguards might you
build into a primary care setting to allow more
patients with severe diagnoses to be treated
in that environment?
Group Activity
Four Quadrant Model

Given a clinical case example, use the Curtis and Christian Four
Quadrant Clinical Integration Model 30 and answer the following
questions:
1. What specific needs and goals are a priority for the patient at this
time?
2. Which quadrant offers the best opportunities for the patient to receive
the care they need?
3. Given the setting where the patient is being served, how might that
setting be modified to enhance care?
A final note…

Questions? Thoughts? Comments?

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