Medicine Joins Forces With Social Work — Blueprint for the Future
By Lindsey Getz
Social Work Today
Vol. 19 No. 5 P. 22

A new, first-of-its-kind interprofessional endeavor combines medical and social work knowledge and skills to teach and learn from medical students and social workers in the same setting—a sign of the times and welcome innovation.

Social work and medicine have long gone hand in hand—though that has not necessarily always been recognized. Over the years, some social workers may have felt their value at the table has been overlooked—if not ignored completely. Even social workers who are employed within a hospital setting sometimes feel like an entirely separate entity from any of the care the patient has received up until meeting them. That has been a disservice to everyone. It hurts the patient care experience and also increases the chances of readmittance. With so much talk of patient-centered care and integrative medicine, now is the time for change.

Change is exactly what’s happening in Austin, Texas.

With the implementation of a first-of-its-kind health social work department at Dell Medical School at The University of Texas at Austin, exciting changes are happening. For the first time, future doctors and future social workers will be sitting in some of the same classes and working together at a training level.

“Social work is critical to health care transformation, especially in the face of economic inequality and health disparities existing in our current health system,” says Clay Johnston, MD, PhD, dean of the Dell Medical School, who had a key role in initiating this interprofessional mission. “A social worker starts where the person is and helps identify what matters most to each person. That’s essential in building a health system that places value on better health outcomes based on each individual’s needs.”

Barbara Jones, PhD, MSW, associate dean for health affairs and a professor at the Steve Hicks School of Social Work at The University of Texas at Austin, is the newly appointed inaugural chair of the department of health social work. As the dean of health affairs, she was already serving as a liaison between the School of Social Work and any other health profession or activity on campus—in and of itself, a fairly new position that was leading the school in the direction of true interprofessionalism.

But when Jones says the new medical school was being built from the ground up, it presented a unique opportunity to be able to do something no school has done before—fully integrate social work into the medical school setting with a brand new department. As the inaugural chair, she has helped to oversee and integrate social workers’ roles within the medical school in clinical practice, community engagement, research, and education.

“From day one, social work has been really involved in the development of the new medical school,” Jones says. “We had already been doing interprofessional education and were coteaching with members from medicine, nursing, and pharmacy. But the building of a brand new medical school created an entirely new opportunity to do more.”

Jones says it was Johnston who really pushed for social work to become fully integrated within the new medical school with its own department. After he was hired as the dean, he believed that in order to be truly interprofessional, as the school aimed to be, he wanted to have social work at “all levels of the medical school.”

“It’s amazing to have a dean of a medical school who sees the value in social work,” Jones says. “We are really proud that this was initiated by the medical school, as it demonstrates their understanding of its importance.”

Luis Zayas, PhD, dean of the Steve Hicks School at The University of Texas at Austin and a professor of mental health and social policy, agrees that having a medical school dean who “appreciates what social work means within the health care process” has been instrumental in this endeavor.

“He [Johnston] understands that doctors, nurses, and other medical staff can only do so much,” Zayas says. “But once patients get delivered to the curbside of the hospital, they’re either prepared to go home or they’re not. Clay understands the role of social work in preparing a person to go home, in preparing family members to receive that person. One of the best ways that we can avoid patients coming back into the hospital is to make sure that they were well prepared for their home situation. Clay understands that’s exactly what social work does—and better than any other member in the health care team.”

That understanding made it important that social work become an integrated part of the medical school—learning to work with the team and training right alongside future doctors, nurses, and pharmacists (who are also part of the interprofessional school arrangement).

“In this arrangement, social workers are not outsiders as they often are—or at least feel—in the traditional health care arrangement,” Zayas explains. “We know that there is a pecking order within the traditional system, but Clay understands the only way to break those hierarchies is to have people train together at the medical school level. It’s not so much ‘Who is the boss’ as it is, ‘We all bring our own expertise to the table.’ With that type of understanding, true teamwork is happening, and that’s where the best possible patient care is being delivered.”

The Importance of Social Work in Medicine
While social work has long served a valuable role within health care, some have perceived it as separate from the health care system. Hospital social workers in many systems sometimes have little integration with the rest of the medical staff and may even be employed by an outside organization as opposed to in house—widening that sense of separation. But giving social workers a more equal place on a patient’s medical team is so important to their experience—and their recovery, Johnston says.

“One of the biggest problems with the traditional hierarchy of the health care system is that social workers are considered staff employees rather than partners with the medical team—and that puts patients at a major disadvantage,” Johnston says. “Given the important expertise and unique perspective that social workers bring, we need to have them equally represented at the table. We need the voice of social work in medicine.”

As the health care system begins to look more closely at the social determinants of health and to keep those in mind in terms of treatment, social workers have an invaluable place in that conversation, Jones adds.

“The health care system is finally paying more attention to social determinants of health—and that’s our expertise,” Jones says. “Social work has been looking at that for a long time. As talk about patient-centered care continues to gain momentum, social workers need to be at the forefront of those conversations. Our unique skills in understanding what impacts a person’s health and well-being is a very valuable part of patient care.”

Of course, it’s not enough to just pay attention to the social determinants of health—there also needs to be someone who takes action, Zayas adds.

“We know what those social determinants of health might be for a patient; now how do we intervene and improve their health care and prevent unnecessary, negative outcomes?” he questions. “This is where social workers shine. They are the ones to take action and to implement interventions and ideas that really make a difference in patients’ lives.”

It all comes back to this idea of “patient-centered care,” Jones says. It’s about looking at the whole person and what might be impacting their health—and their ability to recover.

“Having a department of health social work embedded within Dell Medical School ensures that the health care we provide takes into account the whole person—including their family and their community,” Jones adds. “It’s the ‘whole-person care’ that everyone is talking about being put into action.”

A Unique Situation
It’s important to note that this integration within the medical school does not replace the School of Social Work. It is a department—not its own school. The department of health social work at the Dell Medical School is not degree granting. Social work students will still obtain their MSSW through the Steve Hicks School of Social Work (which Jones remains part of). But for social work students who are interested in hospital social work, this department offers that missing link and provides an academic home to practicing social workers.

Currently, Dell Medical School is home to 20 social workers, about one-half of whom provide direct services to patients as part of UT Health Austin, the clinical practice of the medical school. Within UT Health Austin’s clinics, social workers are a critical component of team-based care, working alongside physicians, nurses, dietitians, pharmacists, physical therapists, and other skilled care providers to ensure that all aspects of a patient’s well-being are addressed through personalized care. Social workers at Dell Medical are hired by the medical school and are employees there, not of the university-affiliated hospital.

“As part of our effort to raise the stature and self-esteem of the Dell Medical social workers, we now appoint them to the Steve Hicks School faculty as ‘assistant professor of practice,’” Zayas adds. “They are then eligible for promotion in rank to associate and full professors. We thought that providing an academic title and rank would also enhance their standing among all of the medical school physicians and pharmacists, mostly, who hold professorial titles. As faculty in the school of social work, they engage with our students on a pedagogical level.”

“We are aiming to design high-value care from the ground up, and we’re acknowledging that there are many aspects of care that are better handled by nonmedical professionals,” Johnston adds. “Social workers are fantastic at counseling and intervening where medical professionals cannot—and as medical professionals recognize that, they begin to work as a team. When they start to see what type of impact social workers have on their patients’ outcomes, they want them on their team. So, we’re looking at opportunities to involve medical students and social work students in the same projects early on—at the training level. We’re teaching them to work together in a way that we hope will change the future of health care as it goes more toward a team-based approach.”

The commitment to social work coming from within the medical school (as opposed to social workers vying for a “seat at the table”) sends a powerful message, Jones adds.

“The message it sends to physicians internally is that social work is highly valued around here,” she says. “The message comes directly from the dean of the school—so that carries weight. It also helps social workers to see themselves as equals, which is also important. We want social workers to be able to see themselves as true partners and interprofessional leaders.”

But Jones adds that she hopes that the message is being communicated “beyond Austin.” This is something that all three deans say they believe is bigger than just their school.

“Reimagining social work at leadership levels within hospitals and medical facilities is what we hope for the future,” she says. “I truly believe it’s where we’re headed.”

Hope for the Future
Certainly, the hope is that others will follow suit. Of course, all three deans have noted that the unique circumstances for Dell Medical School—namely, that it’s a brand new facility and program, being built from the ground up—have helped make this possible. As Johnston puts it, “The circumstances gave us a lot of room to move.”

He says that in order for others to follow in their footsteps, there needs to be more willingness to be open-minded.

“These types of changes will be harder in established medical centers where things have been done a certain way for a long time,” Johnston admits. “Those hierarchies and pecking orders are not necessarily easy to overcome. But that’s not to say it’s not doable. Ultimately, it’s a disservice to patients not to see medicine go in this direction.”

Even so, he acknowledges that deans at other medical schools have already expressed interest and asked a lot of questions.

“I think there’s no question that as new medical schools emerge, this is going to become commonplace,” Zayas agrees. “We’re finally seeing more interest—and acknowledgment regarding the importance—in social work. The hurdle will be the established medical schools that have roots and culture.”

But like Johnston, Zayas agrees that hurdle is not insurmountable.

“It will take some level of rethinking and that takes time, but I think if we’re truly talking about integrated health care—and focusing on patient-centered care—then this is the direction we must take,” he continues. “We’re talking a lot about it, but now is the time to start doing something about it. It’s in the training of physicians and how they’re taught to work with a team. We must change the way of thinking with new physicians so that they see social work already embedded into the system—and that’s what they’ll consider the norm. That will change the future.”

“We are the first of our kind, but we don’t want to be the last,” Jones adds. “We want what we’ve done here to be an invitation to others—and we’ve certainly had a lot of interest already both from schools of social work and from medical schools. I believe that interprofessional education and collaborative practice is the way of the future if we’re going to practice what we preach.”

— Lindsey Getz is a Royersford, PA–based freelance writer.