Health Outcomes and Costs of Social Work Services: A Systematic Review

Steketee G, Ross AM, Wachman MK
Source: Am J Public Health
Publication Year: 2017
Patient Need Addressed: Behavioral health, Care Coordination/Management, Chronic Conditions, Homelessness/housing, Maternal/perinatal, Substance Use
Population Focus: Vulnerable/disadvantaged
Intervention Type: Service redesign, Staff design and care management
Study Design: Review
Type of Literature: White
link: https://www.ncbi.nlm.nih.gov/pubmed/29236534
Abstract

BACKGROUND:
Efforts to reduce expensive health service utilization, contain costs, improve health outcomes, and address the social determinants of health require research that demonstrates the economic value of health services in population health across a variety of settings. Social workers are an integral part of the US healthcare system, yet the specific contributions of social work to health and cost-containment outcomes are unknown. The social work profession’s person-in-environment framework and unique skillset, particularly around addressing social determinants of health, hold promise for improving health and cost outcomes.

OBJECTIVES:
To systematically review international studies of the effect of social work-involved health services on health and economic outcomes.

SEARCH

METHODS:
We searched 4 databases (PubMed, PsycINFO, CINAHL, Social Science Citation Index) by using “social work” AND “cost” and “health” for trials published from 1990 to 2017.

SELECTION CRITERIA:
Abstract review was followed by full-text review of all studies meeting inclusion criteria (social work services, physical health, and cost outcomes).

DATA COLLECTION AND ANALYSIS:
Of the 831 abstracts found, 51 (6.1%) met criteria. Full text review yielded 16 studies involving more than 16 000 participants, including pregnant and pediatric patients, vulnerable low-income adults, and geriatric patients. We examined study quality, health and utilization outcomes, and cost outcomes.

MAIN

RESULTS:
Average study quality was fair. Studies of 7 social work-led services scored higher on quality ratings than 9 studies of social workers as team members. Most studies showed positive effects on health and service utilization; cost-savings were consistent across nearly all studies.

CONCLUSIONS:
Despite positive overall effects on outcomes, variability in study methods, health problems, and cost analyses render generalizations difficult. Controlled hypothesis-driven trials are needed to examine the health and cost effects of specific services delivered by social workers independently and through interprofessional team-based care. Public Health Implications. The economic and health benefits reported in these studies suggest that the broad health perspective taken by the social work profession for patient, personal, and environmental needs may be particularly valuable for achieving goals of cost containment, prevention, and population health. Novel approaches that move beyond cost savings to articulate the specific value-added of social work are much needed. As health service delivery focuses increasingly on interprofessional training, practice, and integrated care, more research testing the impact of social work prevention and intervention efforts on the health and well-being of vulnerable populations while also measuring societal costs and benefits is essential.

Insights Results

Overview of article

  • Social work is well positioned to play an increasingly significant role in improving people’s health through prevention, integrated healthcare, and improving the social determinants of health (e.g., housing, employment)
  • This study reviewed almost 30 years of international research to understand whether services provided by social workers as leaders or as team members improved health outcomes and reduced costs
  • 16 studies (7 with a social worker in a leadership role; 9 with a social worker as a team member) met all inclusion criteria and were included in final review for impact of social worker services on health and costs
  • 8 studies focused on vulnerable adult samples examining medical or social problems, including homelessness among those with chronic medical illness, mild stroke, chronic illness-related work absences, soft tissue infections, under- or uninsured adults using medication assistance, risk for admission to skilled nursing facilities, and high rates of use of inpatient and emergency services
  • The studies showed that social work services had positive benefits for both health and economic outcomes for vulnerable adults, children, pregnant women, and older adults

Methods of article

  • This study searched 4 databases (PubMed, PsycINFO, CINAHL, Social Science Citation Index) by using “social work” AND “cost” and “health” for trials published from 1990 to 2017

Results

  • The overall impact of social worker services on health utilization was positive. In the behavioral health arena, social services have demonstrated positive outcomes, particularly in providing mental health services and disseminating early detection interventions for substance abuse. Additionally, in a pregnancy prevention intervention for adolescent mothers, social workers led support groups, provided intensive case management with home visits and phone contact, and coordinated services with the primary care physician.
  • Less is published about the benefits of interventions delivered by social workers to address physical health
  • Nearly all studies showed cost savings (all 8 of the vulnerable population studies reported costs savings). Examples of savings included a housing program that included case management services, which saved more than $6000 per person per year in health, housing, and respite care costs and annual savings of nearly $10,000 for chronically homeless patients

Key takeaways/implications

  • There are 2 defined areas of future research: 1) Assessment of clinical health services led by social workers providing added benefit beyond services that do not involve a social work leader; and 2) Evaluation of inclusion of social workers on interprofessional care teams enhancing health and cost outcomes beyond care provided without social worker involvement
  • Limitations to the study include nonevaluation using direct measures of health outcomes and limited methodology for cost analyses
  • A call to action is needed to encourage social work researchers to lead development and testing of intervention and prevention efforts to improve health outcomes and costs
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