Social determinants of health—such as income, education, food and housing—have a substantial influence on individual health outcomes as well as on health inequities within and between countries (World Health Organization 2008). In fact, countries with greater total investment in health and social care spending compared to health spending alone have seen more positive health outcomes (Bradley et al. 2011; Davis 2015). The social service workforce plays a unique and powerful role in supporting individuals and communities in addressing social and other determinants of health. This role is characterized by application of a person-in-environment approach to assessing needs and facilitating access to needed services, promotion of social justice and human rights, and prevention and response to issues of behavioral and mental health, violence, abuse and neglect. With a social service workforce working in and linked to health facilities, there is much more potential for health systems to not only address clinical needs effectively and efficiently, but to tackle the inequities present in health care provision itself and to work towards more just, people-centered health systems and universal health coverage, in line with Sustainable Development Goal 3.
This paper aims to enable policy makers, civil society and advocacy groups to better articulate the value of the social service workforce in health systems through a presentation of the latest evidence on social service workforce roles, functions and promising practice models, and related influence on health outcomes and costs. Based on interviews, research and data from a range of countries, it outlines key challenges, opportunities and recommendations around effective and sustained deployment of the social service workforce when located in or linked to health facilities.
The cross-cutting advantages or benefits of having social service workers deployed in health facilities are to enable a holistic approach to health care; address the social determinants of health; coordinate integrated care and support by working across sectors and disciplines; provide early identification and coordinated intervention in cases of violence against children, women or elders; and support patients across the life course. Social service workers in health facilities are best equipped to play the roles of behavioral health specialist, care manager, community engagement specialist and multi-level advocate. For health systems to gain the most from the unique skills and competencies of social service workers, care must be taken in determining how these workers are deployed. Models for deployment include the roving or liaison model, the permanent on-site support model and the interprofessional team model. To ensure the social service workforce is properly planned, developed and supported, the following recommendations are proposed:
- inter-ministerial leadership should work together to coordinate planning processes;
- adequate budget and other forms of resourcing must be factored into long-term planning for health facilities in which the social service workforce play a role;
- interprofessional learning opportunities should be cultivated within pre-service education, in-service training and continuing professional development for the social service workforce intending to or currently practicing in health settings;
- field placements (practicum) based in health facilities should be made available for all social service workforce cadre trainees;
- regular, supportive supervision for social service workforce in health settings is vital and should not be overlooked;
- regulatory and policy frameworks to support professional recognition of the social service workforce in health facilities and provide quality assurance should be developed.
