Community Health Work and Social Work Collaboration: Integration in Health Care and Public Health Settings: A Conceptual Framework.

Community health worker (CHW) and social worker (SW) collaboration is crucial to illness prevention and intervention, yet systems often engage the 2 workforces in silos and miss opportunities for cross-sector alignment. In 2021, a national workgroup of over 2 dozen CHWs, SWs, and public health experts convened to improve CHW/SW collaboration and integration across the United States. The workgroup developed a conceptual framework that describes structural, systemic, and organizational factors that influence CHW/SW collaboration. Best practices include standardized training, delineated roles and scopes of practice, clear workflows, regular communication, a shared system for documentation, and ongoing support or supervision.

Structural Factors Contributing to Compassion Fatigue, Burnout, and Secondary Traumatic Stress Among Hospital-Based Healthcare Professionals During the COVID-19 Pandemic.

High levels of burnout among healthcare providers (HCPs) have been a widely documented phenomenon, which have been exacerbated during the COVID-19 pandemic. In the United States, qualitative studies that are inclusive of HCPs in diverse professional roles have been limited. Therefore, we utilized a qualitative-quantitative design to examine professional quality of life in terms of compassion fatigue, burnout, and secondary traumatic stress among hospital-based HCPs, including social workers, hospitalists, residents, and palliative care team members during COVID-19. HCPs (n = 26) participated in virtual semi-structured focus groups or individual interviews and online surveys (n = 30) including the Professional Quality of Life (ProQOL) Scale. While ProQOL scores indicated low levels of compassion fatigue, burnout, and secondary traumatic stress, thematic analysis of our qualitative data included rich descriptions of compassion fatigue, burnout, and secondary traumatic stress. Safety concerns and value misalignment characterized structural stressors perceived to contribute to HCP compassion fatigue, burnout, and secondary traumatic stress. The discrepancy between our qualitative and quantitative findings may be indication that modifications to current screenings are warranted. These findings also suggest a need to identify and implement structural and policy changes that increase HCPs' physical and emotional safety and promote better alignment of institutional interests with HCP values.

Social workers are key to addressing social determinants of health in integrated care settings.

Social workers play an important role in assessing social determinants of health (SDH) and providing behavioral health services in integrated care settings. Evidence suggests that integrated care interventions improve quality of life and other patient outcomes. However, the ambiguous role of social workers on the interdisciplinary team, the lack of protocol in SDH screening and intervention, and restrictions due to healthcare reimbursement limit social workers' ability to intervene. Future directions include standardizing integrated care models, evaluating integrated care's efficacy to address SDH, incorporating SDH into interprofessional training including role clarification and reimbursing for SDH assessment and intervention.

An exploration of financial toxicity among low-income patients with cancer in Central Texas: A mixed methods analysis.

OBJECTIVE: Financial toxicity is of increasing concern in the United States. The Comprehensive Score for Financial Toxicity (COST) is a validated measure; however, it has not been widely utilized among low-income patients and may not fully capture financial toxicity in this population. Furthermore, the relationships between financial toxicity, quality of life (QOL), and patient well-being are poorly understood. We describe the experience of financial toxicity among low-income adults receiving cancer care. We hypothesized that higher financial toxicity would be associated with less income and lower quality of life. Qualitative interviews focused on the financial impact of cancer treatment. METHOD: This study was conducted at a cancer clinic in Central Texas. Quantitative and qualitative data were collected in Fall and Spring 2018, respectively. The quantitative sample (N = 115) was dichotomized by annual income (<$15,000 vs. >$15,000). Outcomes included financial toxicity (COST), quality of life (FACT-G), and patient well-being (PROMIS measures: Anxiety, Depression, Fatigue, Pain Interference, and Physical Function). Associations between quality of life, patient well-being, and financial toxicity were evaluated using linear regression. Sequential qualitative interviews were conducted with a subsample of 12 participants. RESULTS: Patients with <$15k had significantly lower levels of QOL and patient well-being such as depression and anxiety compared to patients with >$15k across multiple measures. A multivariate linear regression found QOL (Β = 0.17, 95% CI = 0.05, 0.29, p = 0.008) and insurance status (Β = -3.79, 95% CI = -7.42, -0.16, p = 0.04), but not income, were significantly associated with financial toxicity. Three qualitative themes regarding patient's access to cancer care were identified: obtaining healthcare coverage, maintaining financial stability, and receiving social support. SIGNIFICANCE OF RESULTS: Low-income patients with cancer face unique access barriers and are at risk for forgoing treatment or increased symptom burdens. Comprehensive assessment and financial navigation may improve access to care, symptom management, and reduce strain on social support systems.

An Intersectional Approach to Understanding Barriers to Healthcare for Women.

Access to health care depends on multiple sociodemographic factors such as race/ethnicity, marital status, education, income, and insurance status. However, a paucity of research has examined access to healthcare disparities as they uniquely affect women, specifically women of color. National data were analyzed from the Medical Expenditure Panel Survey (MEPS) utilizing an 11-year sample (2005-2015) of women ages 18-74 (N = 128,355). More recent data were not included due to changes in how sampling was conducted after 2015. Predictor variables included race/ethnicity cross-classified with marital status, education, income, or insurance status, controlling for age. A dichotomous outcome variable called "any barriers to healthcare" was created based on usual source of care, delayed medical care, delayed dental care and delayed prescription care. Multivariate logistic regression models were used to identify associations with barriers to care. The foundation of this methodology is intersectionality and how it impacts access to care for women across social identities. Hispanic women (OR 1.08, 95% CI 1.02-1.14) had higher odds of having a barrier to care compared to White women. However, Black women (OR 0.92, 95% CI 0.87-0.97) had lower odds of having a barrier to care compared to White women. Race/ethnicity also significantly moderated the relationship between socioeconomic variables (marital status, income, education and insurance status) and having a barrier to care. To achieve a healthy community, addressing these racial/ethnic and socioeconomic inequalities helps to support the people who live and work within these communities.

Exploring the Efficacy of Social Work Interventions in Hospital Settings: A Scoping Review.

Social workers play an integral role in hospitals, particularly as it relates to improving patient outcomes. This scoping review was conducted to explore the impact of social work interventions in hospital settings on healthcare utilization. Research literature was identified using the following search engines: PsycINFO, CINAHL Plus, SocINDEX & MEDLINE. The initial search was conducted in May 2019, and an updated search was conducted in April 2021. Search results identified 2633 references and 110 articles met criteria for full-text review. Eighteen articles were included in the final review. Social work interventions include transitional care (56%), care coordination (22%), behavioral health (17%) and case management (5%). Significant improvements to readmission, mortality and utilizations rates are reported in over 80% of the studies, however the vast majority are non-randomized quantitative studies. More rigorous studies are needed to expand the literature and further evaluate the effectiveness of social work interventions in hospital settings.

Evidence-based family planning services among publicly funded providers in Texas.

BACKGROUND: Healthy Texas Women (HTW) is a fee-for-service family planning program that excludes affiliates of abortion providers. The HTW network includes providers who participate in Title X or the state Family Planning Program (FPP) and primary care providers without additional family planning funding (HTW-only). The objective of this study is to compare client volume and use of evidence-based practices among HTW providers. METHODS: Client volume was determined from administrative data on unduplicated HTW clients served in fiscal year (FY) 2017. A sample of 114 HTW providers, stratified by region, completed a 2018 survey about contraceptive methods offered, adherence to evidence-based contraceptive provision, barriers to offering IUDs and implants, and counseling/referrals for pregnant patients. Differences by funding source were assessed using t-tests and chi-square tests. RESULTS: Although HTW-only providers served 58% of HTW clients, most (72%) saw < 50 clients in FY2017. Only 5% of HTW providers received Title X or FPP funding, but 46% served ≥ 500 HTW clients. HTW-only providers were less likely than Title X providers to offer hormonal IUDs (70% vs. 92%) and implants (66% vs 96%); offer same-day placement of IUDs (21% vs 79%) and implants (21% vs 83%); and allow patients to delay cervical cancer screening when initiating contraception (58% vs 83%; all p < 0.05). There were few provider-level differences in counseling/referrals for unplanned pregnancy (p > 0.05). CONCLUSIONS: HTW-only providers served fewer clients and were less likely to follow evidence-based practices. Program modifications that strengthen the provider network and quality of care are needed to support family planning services for low-income Texans.

Understanding the primary health care experiences of individuals who are homeless in non-traditional clinic settings.

BACKGROUND: Despite the widespread implementation of Health Care for the Homeless programs that focus on comprehensive, integrated delivery systems of health care for people experiencing homelessness, engaging and retaining people experiencing homelessness in primary care remains a challenge. Few studies have looked at the primary care delivery model in non-traditional health care settings to understand the facilitators and barriers to engagement in care. The objective of our study was to explore the clinic encounters of individuals experiencing homelessness receiving care at two different sites served under a single Health Care for the Homeless program. METHODS: Semi-structured interviews were conducted with people experiencing homelessness for an explorative qualitative study. We used convenience sampling to recruit participants who were engaged in primary care at one of two sites: a shelter clinic, n = 16, and a mobile clinic located in a church, n = 15. We then used an iterative, thematic approach to identify emergent themes and further mapped these onto the Capability-Opportunity-Motivation model. RESULTS: Care accessibility, quality and integration were themes that were often identified by participants as being important facilitators to care. Psychological capability and capacity became important barriers to care in instances when patients had issues with memory or difficulty with perceiving psychological safety in healthcare settings. Motivation for engaging and continuing in care often came from a team of health care providers using shared decision-making with the patient to facilitate change. CONCLUSION: To optimize health care for people experiencing homelessness, clinical interventions should: (1) utilize shared-decision making during the visit, (2) foster a sense of trust, compassion, and acceptance, (3) emphasize continuity of care, including consistent providers and staff, and (4) integrate social services into Health Care for the Homeless sites.

Interprofessional collaboration between social workers and community health workers to address health and mental health in the United States: A systematised review.

Collaboration between social workers (SW) and community health workers (CHW) plays an essential role in addressing health inequities in the United States (US). However, little is known about the current state of CHW/SW collaboration. The objectives of this review were to identify (a) the nature, goals and setting of CHWs and SW collaboration; (b) the patient outcomes utilised to measure intervention efficacy. The literature search was conducted in December 2020 using six databases. The inclusion criteria were (1) interventions that included CHWs and SWs; (2) US-based; (3) published between 2000-2020; (4) peer-reviewed journal articles; (5) examining health or mental health outcomes. Search results identified 281 articles, and 15 were included in the final analysis. Settings that utilised SW/CHW collaboration included outpatient clinics (n = 10); community organisations (n = 4) or hospital (n = 1). CHW and SW interventions focused on disease prevention (n = 8), chronic care (n = 4) and mental health (n = 3). Health outcomes were the most evaluated (n = 13), and significant improvement of at least one health outcome was reported in those studies. Mental health outcomes (n = 3) were also significantly improved, while social determinants of health (n = 2) were least common and descriptive only. This is the first review of SW and CHW collaboration. Clarity regarding SW and CHW roles and scopes of practice are needed to understand better SW/CHW collaboration and its impacts on community health outcomes and improve the process of collaboration. SW and CHW collaboration may increase clients' access to preventive care, mental health and address health inequities.

Social workers in integrated care beyond primary care: a scoping review.

Social workers are key members of integrated care (IC) teams, yet there is limited research on the presence and roles of social workers on IC teams. Research literature from 2014 to 2021 was identified using the following search engines: Academic Search Complete, PsycINFO, CINAHL Plus, SocINDEX and MEDLINE. An exploratory search was conducted in January 2021 and an updated search was conducted in August 2021. This search resulted in 802 references, 50 of which met criteria for full-text review. Nine articles were identified through supplemental searching. 20 articles were included in the final review. Of the 20 studies included, most were randomized control trials (45%; n = 9). Studies varied across settings including specialty care (40%; n = 8), community-based practices (35%; n = 7), and primary care (25%; n = 5). Social workers engaged in a variety of roles including behavioral interventions, care coordination, and intake assessment. Social workers are engaged in IC in a variety of roles across healthcare settings. Findings suggest that patients' mental health outcomes improve in IC settings which include social workers. Future research is needed to isolate the impact that social workers have in IC. Social workers are key members of integrated care teams, yet there is a need to explore their roles on these teams. Using a methodological approach, research literature from 2014 to 2021 was explored to establish the roles, responsibilities, and settings of social workers on integrated care teams. Of the 20 articles included in the review, social workers held various roles including intake assessment, care coordination, and behavioral interventions, such as psychotherapy or cognitive behavioral therapy. Findings suggest that social workers are on integrated care teams in a variety of roles across various healthcare settings and that patients' mental health outcomes improve in integrated care settings that include social workers.

Nativity moderates the relationship between nationality and healthcare access for some Latinx women in the United States.

OBJECTIVES: Gender has been identified as a social determinant of health, particularly as it relates to healthcare access for women of color. Yet, few analyses focus on the unique barriers that impact Latinx women's access to healthcare, which demonstrates a significant gap in the literature given the heterogeneity of the Latinx population. The purpose of this study is to (1) describe how sociodemographic characteristics impact access to healthcare for Latinx women and (2) examine whether intersecting factors, particularly nativity and nationality, influence barriers to healthcare for Latinx women in the United States (US). DESIGN: An outcome variable called 'any barriers to care' was created based on four healthcare access variables: lacking a usual source of care and delayed care (medical, dental and prescription). Data were from the Medical Expenditure Panel Survey (2005-2015). The sample included Latinx women between ages 18 and 74 (N = 27,162), cross-classified by nationality and nativity. Control variables included language, age, marital status, education, income, and insurance status. Multivariate logistic regression models were used to assess nativity and nationality as a predictor of any barriers to care. RESULTS: 37% of the sample experienced at least one barrier to care. Initially, nativity status was not a predictor of having a barrier to care. However, in adjusted models with cross-classified nativity and nationality variables, Mexican (US- and foreign-born), Cuban (US- and foreign-born) and Central/South American women (foreign-born only) had higher odds of having any barriers to care compared to continental US-born Puerto Rican women. CONCLUSIONS: Latinx women experience barriers to healthcare, yet the prevalence rates vary widely depending on nationality and nativity. It is important to recognize the heterogeneity that exists within the Latinx community and address the underlying causes for limited healthcare access such as immigration policy.

Contributing Risk Factors for Substance Use Among Youth in Postconflict Liberia.

Substance use is prevalent among youth in postconflict African countries and is associated with a number of public health problems such as poverty, child homelessness, and school truancy. This qualitative study explores the risk factors associated with substance use among Liberian youth from the perspective of public-school students. Nine focus groups were conducted with 72 Liberian public-school students (35 female, 37 male). Multiple risk factors for substance use among Liberian youth were identified through qualitative analysis, including emotional instability, gender, fear of academic failure, accessibility to substances within the school and community, poverty, and unintentional drug use. These findings are important to public health campaigns and postconflict recovery in Liberia, and may also inform prevention programs for substance use among Liberian youth.

The impact of transactional sex with teachers on public school students in Monrovia, Liberia - a brief report.

Access to education has been shown to strongly influence adolescent health across the world, and strong relationships with teachers has been found to lead to better academic and psychosocial outcomes for students. In many low-income countries where adolescents have less access to education and are more likely to experience poor health outcomes, risky sexual behaviors can exacerbate these challenges by increasing the risk of unintended pregnancy and sexually transmitted infections. This study sought to examine risky behaviors, such as substance use and risky sexual practices, of in-school youth in Liberia, a country in West Africa. Nine focus groups were conducted with public school students in Monrovia, Liberia in April 2012 using a semi-structured guide. The sessions took place in three public schools with n = 72 participants aged 12-20 years old. Following thematic content analysis, a pattern emerged of transactional sex between female students and male teachers, which often led to contrived and coercive relationships for the students. Conversely, participants reported that educators were not disciplined for having sex with students. Interventions to reduce the prevalence of transactional sex within the academic environment would likely protect the well being of school-going youth, particularly female youth, and support students' academic pursuits in Liberia.

A Qualitative Analysis of Substance Use among Liberian Youth: Understanding Behaviors, Consequences, and Protective Factors Involving School Youth and the School Milieu.

OBJECTIVE: Substance use is a significant and common problem among school-aged youths throughout Africa. Like other countries on this continent, the West-African nation of Liberia is recovering from civil war. A well-educated population of young people is critical to the recovery efforts and long-term success of Liberia. Substance use by school-aged youths has important public health consequences that could undermine Liberia's post-conflict recovery efforts. We wanted to better understand the culturally significant themes and subthemes related to substance use among youths attending public schools in Monrovia, Liberia. METHODS: A qualitative research design was used to collect data from 72 students attending public school in Monrovia, Liberia. Nine focus groups of 6-8 students from three public schools were facilitated using a semi-structured format to guide discussions on substance use. Student narratives were translated and re-occurring themes and subthemes were coded and analyzed. RESULTS: Four emergent themes described in this study were: Behaviors associated with substance useConsequences associated with individual useConsequences of substance use that affected the school milieuSchool-related factors that were protective from substance use.Subthemes associated with substance use included concealment of substances, intoxication and disruption of the classroom environment, expulsion from school, school drop-out, and school as protective against substance use. CONCLUSION: Liberian school-aged youths described important themes and subthemes associated with substance use occurring within the school milieu. These data have germane public health ramifications, and could help inform larger epidemiologic study methods and public health interventions for Liberia and countries with similar profiles.

Posttraumatic Stress Disorder Symptoms and Social and Occupational Functioning of People With Schizophrenia.

This study sought to clarify the contribution of posttraumatic stress disorder (PTSD) to interpersonal and occupational functioning in people with schizophrenia. Self-report questionnaires and semistructured interviews were used to evaluate PTSD and brain injury, positive symptoms, depression, substance abuse, occupational and social functioning, and intelligence. Multiple regressions assessed the relationship between predictors and functional impairment. Posttraumatic stress disorder symptoms were present in 76% of participants, with 12% of participants meeting diagnostic criteria for PTSD. Participants with PTSD had higher rates of depression and more severe positive symptoms. Results of multiple regressions indicated that PTSD symptoms were the only significant predictor of patient-rated interpersonal and occupational functioning. Posttraumatic stress disorder symptoms were not associated with interviewer-rated interpersonal or occupational functioning or employment. While more research is needed, screening and treatment for exposure to traumatic events and PTSD symptoms might be indicated for individuals with schizophrenia. Availability of PTSD assessment and evidence-based treatments for people with schizophrenia is a crucial and often unmet health service need.

Disrupted Working Memory Circuitry in Schizophrenia: Disentangling fMRI Markers of Core Pathology vs Other Aspects of Impaired Performance.

Working memory (WM) impairment, a core feature of schizophrenia, is often associated with aberrant dorsolateral prefrontal cortex (dlPFC) activation. Reduced resting-state connectivity within the frontoparietal control network (FPCN) has also been reported in schizophrenia. However, interpretation of WM-related dlPFC dysfunction has been limited by performance differences between patients and controls, and by uncertainty over the relevance of resting-state connectivity to network engagement during task. We contrasted brain activation in 40 schizophrenia patients and 40 controls during verbal WM performance, and evaluated underlying functional connectivity during rest and task. During correct trials, patients demonstrated normal FPCN activation, despite an inverse relationship between positive symptoms and activation. FPCN activation differed between the groups only during error trials (controls>patients). In contrast, controls demonstrated stronger deactivation of the ventromedial prefrontal cortex (vmPFC) during correct and error trials. Functional connectivity analysis indicated impaired resting-state FPCN connectivity in patients, but normal connectivity during task. However, patients showed abnormal connectivity among regions such as vmPFC, lateral orbitofrontal cortex, and parahippocampal gyrus (PHG) during both rest and task. During task, patients also exhibited altered thalamic connectivity to PHG and FPCN. Activation and connectivity patterns that were more characteristic of controls generally correlated with better performance. In summary, patients demonstrated normal FPCN activation when they remained on-task, and exhibited normal FPCN connectivity during WM, whereas vmPFC deactivation differences persisted regardless of WM performance. Our findings suggest that altered FPCN activation in patients reflects performance difference, and that limbic and thalamic dysfunction is critically involved in WM deficits in schizophrenia.

A randomized placebo-controlled pilot study of pravastatin as an adjunctive therapy in schizophrenia patients: effect on inflammation, psychopathology, cognition and lipid metabolism.

OBJECTIVE: The aim of this study was to investigate the role of pravastatin, as an adjunctive therapy, on inflammatory markers, lipid and glucose metabolism, psychopathology, and cognition in subjects with schizophrenia and schizoaffective disorder. METHODS: Schizophrenia or schizoaffective subjects (N=60) were randomized to receive either a 12-week supply of pravastatin 40 mg/day or placebo treatment. Anthropometric measures, lipids and glucose metabolism, inflammatory markers, psychopathology and cognitive performance were assessed at baseline, 6 weeks and 12 weeks. RESULTS: Pravastatin use was associated with a significant decrease in total cholesterol, low density lipoprotein (LDL) cholesterol and LDL particle number levels, but was not associated with any significant changes in cognition or psychopathology in the participants, except a significant decrease in the Positive and Negative Syndrome Scale (PANSS) positive symptom score from baseline to week 6. However, this decrease failed to remain significant at 12 weeks. Interestingly, triglycerides, LDL-cholesterol, total cholesterol, LDL particle number, small LDL particle number, large very low density lipoprotein (VLDL) particle number and C-reactive protein (CRP) followed a similar pattern at 6 and 12 weeks as psychopathology. CONCLUSIONS: These results suggest that a randomized trial with a larger sample size and a higher dosage of pravastatin would be helpful in further evaluating the anti-inflammatory properties of pravastatin, its association with improvements in cognitive symptoms, and its potential to reduce positive and negative symptoms associated with schizophrenia or schizoaffective disorders.

Development and validation of the Eating Pathology Symptoms Inventory (EPSI).

Many current measures of eating disorder (ED) symptoms have 1 or more serious limitations, such as inconsistent factor structures or poor discriminant validity. The goal of this study was to overcome these limitations through the development of a comprehensive multidimensional measure of eating pathology. An initial pool of 160 items was developed to assess 20 dimensions of eating pathology. The initial item pool was administered to a student sample (N = 433) and community sample (N = 407) to determine the preliminary structure of the measure using exploratory and confirmatory factor analyses. The revised measure was administered to independent samples of patients recruited from specialty ED treatment centers (N = 158), outpatient psychiatric clinics (N = 303), and students (N = 227). Analyses revealed an 8-factor structure characterized by Body Dissatisfaction, Binge Eating, Cognitive Restraint, Excessive Exercise, Restricting, Purging, Muscle Building, and Negative Attitudes Toward Obesity. Scale scores showed excellent convergent and discriminant validity; other analyses demonstrated that the majority of scales were invariant across sex and weight categories. Eating Pathology Symptoms Inventory scale scores had excellent internal consistency (median coefficient alphas ranged from .84-.89) and reliability over a 2- to 4-week period (mean retest r = .73). The current study represents one of the most comprehensive scale development projects ever conducted in the field of EDs and will enhance future basic and treatment research focused on EDs.