The key to treating the whole person is by addressing barriers and determinants of health in the environment. This can be achieved by integrating community supports into the primary health care system. NASW has developed a Community in Primary Care (CPC) model. This model includes the addition of Masters level social workers (MSW) and community health workers (CHW) into the Primary health care system.
The CPC model places a social worker in the primary care office to work with the physician as a part of an interdisciplinary team. Their job will not interfere or take the place of the physician; their job will be to address the psychosocial needs of the patient. Studies have found that social workers provide many benefits to the primary care system. In the CPC model social workers will work directly with patients to provide case management, brief crisis intervention, and work side by side with the CHW.
Community health workers are a critical part of this model. It is the CHW who implements both the doctor and social worker’s treatment plans. This involves ensuring patients are taking their prescriptions and complying with doctors order. CHWs can attend appointments with patients, and help them navigate the health care system as well as available community supports. Studies have found that community health workers are a huge asset to the primary care system. CHWs have been known to reduce depression in patients, improve preventative care and overall access to medical services.
NASW-Michigan Chapter (2015) reports that by adding social workers and community health workers to the primary care system will help save money. They found that the addition of a social worker alone to primary care saves $90 per patient. Research shows a cost savings of $2.28 to $5.56 for every $1.00 invested in community health workers. Studies suggest that the Community in Primary Care model will continue to reduce costs and increase savings on health care.
How does the CPC work? “CR is a 69 year old male who is seeing his primary care physician for a hospital follow-up visit. He was originally admitted to the hospital for exacerbation of Chronic Obstructive Pulmonary Disease (COPD) and Pneumonia. CR lives alone and has very little community or family support. CR is also a hoarder. His home is very dusty and cluttered.
CR has also been diagnosed with Shingles and cannot afford the medication that prevents flare-ups. He has Medicare, but has had a difficult time applying for Medicaid and finding affordable Medigap insurance. CR is also illiterate and is unable to complete paperwork or apply for assistance.”
The Community in Primary Care model will not only address CR’s health needs but it will address the barriers to meeting those needs. For example, the physician can refer CR to the in-office social worker to assess his psychosocial needs. This includes his mental health, housing, access to health insurance. The social worker can develop an intervention or treatment plan in which the community health worker will implement with the patient. The social worker is also able to address mental health issues like hoarding. The CHW is able to attend appointments with CR insuring that he fully understands his condition, limitations, and treatment. The CHW can also assist CR in filling out necessary paper work and applications for assistance.
In conclusion, having LMSWs and CHWs in the primary care physician offices will provide patients with comprehensive care, the resources to overcome barriers that prohibit better health care and positive health outcomes. Many patients can start to live a healthier, happier lifestyle, because all aspects of their life are being addressed and improved by the multidisciplinary team. Overall, integration of community supports in the primary care system will make the system more efficient in cost, improve the quality of care, and will ultimately provide a system in which the whole person is treated.
Christina Adams, Amber Deciech, Nichole Grubaugh, and Amanda Limon are MSW candidates at Michigan State University.