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

1. Shelley L. Craig, PhD, RSW Assistant Professor RalucaBejan MSW student Barbara Muskat, PhD, RSW Social Work Director, The Hospital for Sick Children MAKING THE INVISIBLE VISIBLE: Are Medical Social Workers Addressing the Social Determinants of Health?

2. Purpose • This study explores if health social workers (HSWs) are addressing the vast range of social determinants of health (SDH) within their practice.

3. 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.

4. 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).

5. 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?

6. 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

7. Social Determinants of Health (SDH) SES • Income & its Distribution • Unemployment & Employment Security • Education • Employment & • Working Conditions • Early Life

8. Social Determinants of Health (SDH) SOCIAL SUPPORTS • Housing • Social Safety Net • Food Security

9. Social Determinants of Health (SDH) DIVERSITY & EQUITY • Gender • Racism • Aboriginal Status • Disability Status • Social Exclusion

10. Social Determinants of Health (SDH) HEALTH CARE SERVICES

11. 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

12. SW Participants’ Demographic Characteristics

13. Social Work Impact on SDH: Frequencies and Correlations

14. 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 (egthose 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

15. Discussion The focus on proximal/ tangible SDH may be related to: 1) The short term nature of patient contact in health/hospital social work 2) The needs of the health care setting and the reason social workers are hired 3) 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 YET Social workers expressed guilt that they werent addressing the most complex determinants and seemed to brush over the provision of tangible benefits.

16. 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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19. Thank You! • Shelley L. Craig, PhD, RSW • Shelley.craig@utoronto.ca