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

• Published in: American journal of public health (1971) 2017-12, Vol.107 (S3), p.S256-S266
• Main Authors: Steketee, Gail, Ross, Abigail M, Wachman, Madeline K
• Format: Article
• Language: English
• Subjects: Adults; AJPH Research; Case management; Chronic illnesses; Citation indexes; Clinical outcomes; Containment; Cost analysis; Cost benefit analysis; Cost control; Cost engineering; Cost reduction; Criteria; Data collection; Disease prevention; Economic research; Economics; Geriatrics; Health care expenditures; Health care policy; Health problems; Health Professionals; Health research; Health Service Delivery; Health services; Health services utilization; International studies; Intervention; Leadership; Low income groups; Medical personnel; Mental health; Older people; Patient Protection & Affordable Care Act 2010-US; Patients; Pediatrics; Population; Pregnancy; Prevention; Primary care; Public health; Public Health Practice; Savings; Search strategies; Social Science; Social sciences; Social services; Social work; Social workers; Systematic review; Teams; Value; Vulnerability; Well being
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2017.304004

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 health care 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. To systematically review international studies of the effect of social work-involved health services on health and economic outcomes. 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. Abstract review was followed by full-text review of all studies meeting inclusion criteria (social work services, physical health, and cost outcomes). 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. 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. 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 inter