MAKING THE INVISIBLE VISIBLE: Are Medical Social Workers Addressing the Social Determinants of Health? Shelley L. Craig, PhD, RSW Assistant Professor Raluca.

MAKING THE INVISIBLE VISIBLE: Are Medical Social Workers Addressing the Social Determinants of Health?

Shelley L. Craig, PhD, RSW

Assistant Professor

Raluca BejanMSW student

Barbara Muskat, PhD, RSW

Social Work Director, The Hospital for Sick

Children

Purpose This study explores if health social

workers (HSWs) are addressing the vast range of social determinants of health (SDH) within their practice.

Social Determinants of Health It is increasingly recognized that the social

determinants of health and the associated health disparities cannot be addressed without intervention in the social circumstances of patients (Schrecker, Chapman, Labonte, & De Vogli, 2010).

This is a role that, historically, has been fulfilled by social workers in the health care system.

Health Social Work Health social workers (HSW) bring an ecological

perspective to health care, by incorporating a full range of psychological and emotional factors (Rachman, 1995) and attention to how individuals interaction with larger social systems influences their health (Claiborne & Vandenburgh, 2001).

HSW work collaboratively as part of institutional and community interprofessional teams to support recovery, to promote quality of life in the context of chronic illness and disability, and to advocate for societal change to address social disadvantages (Praglin, 2007).

The Changing Nature of Health Social Work

Social workers delivering services in health care face unique challenges and opportunities in a rapidly changing environment (Kim & Lee, 2009).

Almost 50% of all registered SWs in the province of Ontario are employed in medical settings

We talk about how we influence the SDH but how?

Social Determinants of Health (SDH)

SDH have been defined as the cumulative environmental factors shaping individuals’ health status

SDH are leveled along several axes of social stratification Socio-Economic Status (SES) Social Supports Diversity & Equity Health Care Services

Social Determinants of Health (SDH)

SES

Income & its Distribution

Unemployment & Employment Security

Education

Employment & Working Conditions

Early Life

Social Determinants of Health (SDH)

SOCIAL SUPPORTS

Housing

Social Safety Net

Food Security

Social Determinants of Health (SDH)

DIVERSITY & EQUITY

Gender

Racism

Aboriginal Status

Disability Status

Social Exclusion

Social Determinants of Health (SDH)

HEALTH CARE SERVICES

METHODS Survey of SW professionals (n= 54) employed at

major hospitals across Toronto

Measures: Basic demographic information (age, race, gender

identity, sexual orientation, educational degree) Job details (number of years in social work practice,

number of years in a health care setting, job title) Number and type of SDH addressed through public

health practice

Analyses: SPSS 19.0: descriptive statistics, correlations and

chi-square analyses

SW Participants’ Demographic Characteristics

Social Work Impact on SDH: Frequencies and Correlations

Discussion Social workers in health care are actively addressing the social determinants of health in their daily practice

Specifically, SWs are addressing SES (Income Distribution and Unemployment)and Social Supports (Housing and the Social Safety Net) Statistically significant correlations were observed with the

variables of each SDOH construct (eg those actively addressing Housing were also more likely to address the Food Security and Social Safety Net determinants)

SDH related to Diversity and Equity, such as Racism, Aboriginal Status, Gender and Social Exclusion, are not addressed as frequently in daily practice Statistically significant associations - SWs failing to address

one determinant might innately leave the subsequent other unaddressed

DiscussionThe focus on proximal/ tangible SDH may be related to:1) The short term nature of patient contact in health/hospital social work2) The needs of the health care setting and the reason social workers are hired3) The importance of addressing the most pressing needs first (food).4) The limitations faced by HSW practicing in health care systems to address complex determinants

This means that the presence of HSW is incredibly important for the most vulnerable populations YETSocial workers expressed guilt that they werent addressing the most complex determinants and seemed to brush over the provision of tangible benefits.

Conclusions Social work practice in health is now at crossroads

It needs to critically examine its ability to establish a social justice framework and apply a bio-psycho social perspective within these settings.

Future research should incorporate more comprehensive measures of SDH and investigate the ways in which client outcomes are influenced by SW interventions

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Thank You! Shelley L. Craig, PhD, RSW

[email protected]