Director, Public Relations, Authority Health
The health system is undergoing a seismic shift, from a sick care model to a wellness model. Wellness begins, of course, with a healthy birth and infancy, and social conditions that promote optimal health. For disenfranchised populations, subject to negative social determinants, well-being may be lost early on. The opportunity, however, is to redefine wellness in terms of restoring psychosocial balance, management and improvement in the disease condition, and minimizing reliance on expensive health care resources.
Chronic illness -- diabetes, hypertension, lung diseases -- plague society, contributing to emergency hospitalization and disability. These are often complex illnesses, compromised among vulnerable populations by social determinants, such as substandard housing, lack of adequate transportation, unemployment, unsafe communities, low literacy level, exposure to chronic stress, and living in a toxic natural environment. These determinants impact the individual's ability to achieve optimum wellness.
Multidisciplinary case management has long been used to provide optimum medical and psychosocial care for people with complex ailments. Medical social workers often play a significant role working with the individual, as well as garnering resources required to help people manage their disease. Increasingly, health providers are realizing that care for people with chronic illness is best provided as close to the home as possible, often within supportive environments such as wellness centers.
Wellness centers are non-clinical environments linked to primary care providers, which are lower cost and accessible to clients on a regular basis. Among vulnerable communities, such as older adults, ethnic minorities, and low income populations, wellness centers function like community centers that promote psychosocial well-being, while addressing chronic disease. Perhaps the most essential component is case management and the individual's commitment to achieve improvement.
This is where social workers are uniquely prepared. Managing chronic disease requires a thorough understanding of the disease process; however, with people who are unable to manage their disease there are often several complicating factors -- including an individual's response to the disease -- in which a social worker can demonstrate an influential role.
Sometimes this role is referred to as a health coach. Similar to the quasi-therapeutic role of "life coach" that often help people redirect their lives through strategic intervention, the health coach helps people attain health literacy, skills, tools, and confidence to become active participants in their care so they can better manage their disease. "Social workers are well-equipped for this role as they receive significant exposure to coaching principles during their training and often apply them in their work to promote patient behavior change," according to Bennett, Coleman, Parry, Bodenheimer, and Chen (2010, p.1).
Grace Christ, DSW, and Sadhna Diwan, PhD (2009) note that "managing chronic illness presents a profound challenge to the social work profession, not only because of the myriad formal and informal services required..." (Christ & Diwan, 2009, p. 1). Their article focuses on chronic illness in elders, but the principals likely apply to younger populations as well. They identify three main characteristics of chronic illness to be considered by social workers:
1. The illness process has changed from an acute terminal course to longer chronic periods.
2. Longer periods of chronic illness has been shown through research to be highly stressful for both patients and their families.
3. More therapeutic strategies will need to be provided in the home and alternative care settings for fiscal and humanistic reasons, with greater reliance on family members for support.
Social workers are well-prepared to assume these complex roles for people with chronic illness. Social workers are poised to play a pivotal role collaborating with medical providers, health education resources, and human services to support individuals with chronic illness move to an increased level of wellness (Hopp, Camp & Perry, 2015).
Bennett, H.D., Coleman E.A., Parry, C., Bodenheimer, T. & Chen E.H. (2010). Health coaching for patients with chronic illness. Family Practice Management. 17(5), 24-29.
Christ, G., & Diwan, S. (2009). The role of social work in managing chronic illness care. Alexandria, VA: Gero Ed Center, Council on Social Work Education. Retrieved from: http://www.cswe.org/CentersInitiatives/CurriculumResources/MAC/Reviews/Health/22419/22454.aspx
Hopp, F.P., Camp, J.K., & Perry, T. (2015). Addressing heart failure challenges through illness-informed social work. Health & Social Work, 40(3), 201-208.