INTEGRATING
SOCIAL CARE INTO THE
DELIVERY OF HEALTH CARE
MOVING UPSTREAM TO
IMPROVE THE NATION’S HEALTH
Committee on Integrating Social Needs Care into the Delivery of
Health Care to Improve the Nation’s Health
Board on Health Care Services
Health and Medicine Division
A Consensus Study Report of
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by agreements between the National Academy of Sciences and Archstone Foundation; Association of Oncology Social Work; Bader Philanthropies; Chicago Community Trust; Community Memorial Foundation; Council on Social Work Education; Episcopal Health Foundation; Health Foundation of Western and Central New York; Healthy Communities Foundation; Helen Rehr Center for Social Work Practice; Josiah Macy Jr. Foundation; Kaiser Permanente National Community Benefit; National Association of Social Workers (NASW) and NASW Foundation; New York Community Trust; Robert Wood Johnson Foundation; SCAN Foundation; and Society for Social Work Leadership in Health Care.
Additional support was obtained from the Boston University Center for Innovation in Social Work and Health social work academic program match campaign. Contributing academic programs were Adelphi University School of Social Work; Baylor University Diana R. Garland School of Social Work; Binghamton University SUNY College of Community and Public Affairs Department of Social Work; Boston College School of Social Work; Brown School at Washington University in St. Louis; California Association of Deans and Directors of Social Work Programs; Case Western Reserve University Jack, Joseph, and Morton Mandel School of Applied Social Sciences; Clark Atlanta University Whitney M. Young, Jr., School of Social Work; Colorado State University–Pueblo Department of Social Work; Colorado State University School of Social Work; Columbia University School of Social Work; Erikson Institute Graduate School in Child Development; Fordham University Graduate School of Social Service; Georgia State University School of Social Work; Howard University School of Social Work; Long Island University Social Work, Brooklyn and Post campuses; Loyola University Chicago School of Social Work; Monmouth University School of Social Work; New York State Association of Deans and Directors of Schools of Social Work; New York University Silver School of Social Work; North Carolina State University School of Social Work; Portland State University School of Social Work; Rutgers University School of Social Work; Saint Louis University School of Social Work; Salem State University School of Social Work; San Diego State University School of Social Work; Simmons University School of Social Work; Smith College School for Social Work; Springfield College School of Social Work; St. Louis Group for Excellence in Social Work Research and Education; Stephen F. Austin State University School of School Work; SUNY Stony Brook School of Social Welfare; The Ohio State University College of Social Work; The University of Alabama School of Social Work; The University of Chicago School of Social Service Administration and Center for Health Administration Studies; The University of Southern Mississippi School of Social Work; The University of Texas at Arlington School of Social Work; The University of Utah College of Social Work; University at Albany SUNY School of Social Welfare; University at Buffalo SUNY School of Social Work; University of California, Berkeley, School of Social Welfare; University of California, Los Angeles, Luskin School of Public Affairs Department of Social Welfare; University of Cincinnati School of Social Work; University of Connecticut
School of Social Work; University of Georgia School of Social Work; University of Hawaii at Manoa Myron B. Thompson School of Social Work; University of Houston Graduate College of Social Work; University of Illinois at Chicago Jane Addams College of Social Work; University of Kentucky College of Social Work; University of Louisville Kent School of Social Work; University of Maryland School of Social Work; University of Michigan School of Social Work; University of Missouri School of Social Work; University of North Carolina at Chapel Hill School of Social Work; University of North Carolina at Charlotte School of Social Work; University of Oklahoma Anne and Henry Zarrow School of Social Work and Center for Social Work in Healthcare; University of Pittsburgh School of Social Work; University of South Carolina College of Social Work; University of South Florida School of Social Work; University of Southern California Suzanne Dworak–Peck School of Social Work; University of Washington School of Social Work; University of Wisconsin–Milwaukee Helen Bader School of Social Welfare; University of Wisconsin–Whitewater Department of Social Work; and Westfield State University Department of Social Work. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-49343-7
International Standard Book Number-10: 0-309-49343-9
Digital Object Identifier: https://doi.org/10.17226/25467
Library of Congress Control Number: 2019951417
Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
Copyright 2019 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Integrating social care into the delivery of health care: Moving upstream to improve the nation’s health. Washington, DC: The National Academies Press. https://doi.org/10.17226/25467.
The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.
The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.
The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.
The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.
Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.
Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.
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COMMITTEE ON INTEGRATING SOCIAL NEEDS CARE INTO THE DELIVERY OF HEALTH CARE TO IMPROVE THE NATION’S HEALTH
KIRSTEN BIBBINS-DOMINGO (Chair), Lee Goldman, M.D., Endowed Chair in Medicine; Professor and Chair, Department of Epidemiology and Biostatistics, University of California, San Francisco
TOYIN AJAYI, Chief Health Officer, Cityblock Health
TAMARA CADET, Associate Professor, School of Social Work, Simmons University
LISA A. COOPER, Bloomberg Distinguished Professor, James F. Fries Professor of Medicine, Director, Johns Hopkins Center for Health Equity, Johns Hopkins University School of Medicine and Bloomberg School of Public Health
KAREN DeSALVO, Professor of Medicine, The University of Texas at Austin, Dell Medical School
CHRIS ESGUERRA, Senior Medical Director, Blue Shield of California
JANET C. FRANK, Adjunct Associate Professor, Faculty Associate, University of California, Los Angeles (UCLA) Center for Health Policy Research, UCLA Fielding School of Public Health
RACHEL GOLD, Senior Investigator, Kaiser Permanente Northwest Center for Health Research and Lead Research Scientist, OCHIN
ROBYN GOLDEN, Associate Vice President, Population Health and Aging, Rush University Medical Center
LAURA GOTTLIEB, Director, Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
SEAN JOE, Benjamin E. Youngdhal Professor of Social Development, Brown School, Washington University in Saint Louis
CHRISTOPHER KOLLER, President, Milbank Memorial Fund
CINDY MANN, Partner, Manatt, Phelps & Phillips, LLP
DIANA J. MASON, Senior Policy Service Professor, Center for Health Policy and Media Engagement, School of Nursing, The George Washington University
KEDAR MATE, Chief Innovation and Education Officer, Institute for Healthcare Improvement
EDWARD SALSBERG, Director of Health Workforce Studies, Health Workforce Institute, The George Washington University
ELIZABETH CUERVO TILSON, State Health Director and Chief Medical Officer, North Carolina Department of Health and Human Services
KEEGAN WARREN-CLEM, Director, Austin Medical–Legal Partnership, Texas Legal Services Center and People’s Community Clinic
Study Staff
ABIGAIL MITCHELL, Study Director
MEGAN KEARNEY, Associate Program Officer
ANNALEE GONZALES, Administrative Assistant
MICAH WINOGRAD, Financial Officer
SHARYL NASS, Director, Board on Health Care Services
Consultants
AMBER HALEY, Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
ALLISON MYERS, Director, Oregon State University Center for Health Innovation
Editorial Consultant
ROBERT POOL
Reviewers
This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by SUSAN CURRY, The University of Iowa, and BRADFORD H. GRAY, Urban Institute. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
Acknowledgments
We, the members of the National Academies of Sciences, Engineering, and Medicine’s Committee on Integrating Social Needs Care into the Delivery of Health Care to Improve the Nation’s Health, wish to express our sincere gratitude to the many individuals and groups who helped with this report.
Our work would not have been possible without the generosity of the sponsors. We would like to thank Archstone Foundation; Association of Oncology Social Work; Bader Philanthropies; Chicago Community Trust; Community Memorial Foundation; Council on Social Work Education; Episcopal Health Foundation; Health Foundation of Western and Central New York; Healthy Communities Foundation; Helen Rehr Center for Social Work Practice; Josiah Macy Jr. Foundation; Kaiser Permanente National Community Benefit; National Association of Social Workers (NASW) and NASW Foundation; New York Community Trust; Robert Wood Johnson Foundation; SCAN Foundation; and Society for Social Work Leadership in Health Care. We also would like to thank the social work academic programs that contributed to this work through a match campaign sponsored by the Boston University Center for Innovation in Social Work and Health:
California Association of Deans and Directors of Social Work Programs
Case Western Reserve University Jack, Joseph, and Morton Mandel School of Applied Social Sciences
Clark Atlanta University Whitney M. Young, Jr., School of Social Work
Colorado State University–Pueblo Department of Social Work
Colorado State University School of Social Work
Columbia University School of Social Work
Erikson Institute Graduate School in Child Development
Fordham University Graduate School of Social Service
Georgia State University School of Social Work
Howard University School of Social Work
Long Island University Social Work, Brooklyn and Post campuses
Loyola University Chicago School of Social Work
Monmouth University School of Social Work
New York State Association of Deans and Directors of Schools of Social Work
New York University Silver School of Social Work
North Carolina State University School of Social Work
Portland State University School of Social Work
Rutgers University School of Social Work
Saint Louis University School of Social Work
Salem State University School of Social Work
San Diego State University School of Social Work
Simmons University School of Social Work
Smith College School for Social Work
Springfield College School of Social Work
St. Louis Group for Excellence in Social Work Research and Education
Stephen F. Austin State University School of School Work
SUNY Stony Brook School of Social Welfare
The Ohio State University College of Social Work
The University of Alabama School of Social Work
The University of Chicago School of Social Service Administration and Center for Health Administration Studies
The University of Southern Mississippi School of Social Work
The University of Texas at Arlington School of Social Work
The University of Utah College of Social Work
University at Albany SUNY School of Social Welfare
University at Buffalo SUNY School of Social Work
University of California, Berkeley, School of Social Welfare
University of California, Los Angeles, Luskin School of Public Affairs Department of Social Welfare
University of Cincinnati School of Social Work
University of Connecticut School of Social Work
University of Georgia School of Social Work
University of Hawaii at Manoa Myron B. Thompson School of Social Work
University of Houston Graduate College of Social Work
University of Illinois at Chicago Jane Addams College of Social Work
University of Kentucky College of Social Work
University of Louisville Kent School of Social Work
University of Maryland School of Social Work
University of Michigan School of Social Work
University of Missouri School of Social Work
University of North Carolina at Chapel Hill School of Social Work
University of North Carolina at Charlotte School of Social Work
University of Oklahoma Anne and Henry Zarrow School of Social Work and Center for Social Work in Healthcare
University of Pittsburgh School of Social Work
University of South Carolina College of Social Work
University of South Florida School of Social Work
University of Southern California Suzanne Dworak–Peck School of Social Work
University of Washington School of Social Work
University of Wisconsin–Milwaukee Helen Bader School of Social Welfare
University of Wisconsin–Whitewater Department of Social Work
Westfield State University Department of Social Work
We are grateful to the Gordon and Betty Moore Foundation and to the National Academy of Medicine’s Culture of Health Program for providing financial support for report dissemination and communications efforts.
Over the course of the study, we received valuable information and insight from a number of individuals with expertise in fields related to health-related social care. Thank you to the presenters at our public meetings:
Kelly Craig, Camden Coalition of Healthcare Providers
Jolene Fassbinder, Archstone Foundation
Kathryn Haslanger, JASA
Reverend Debra Hickman, Sisters Together and Reaching, Inc.
Kristie Kulinski, Administration for Community Living, U.S. Department of Health and Human Services
Natasha Lifton, New York Community Trust
Angelo McClain, National Association of Social Workers
Susan Mende, Robert Wood Johnson Foundation
Tim Rehner, School of Social Work, The University of Southern Mississippi
Susan Reinhard, AARP Public Policy Institute
Victoria M. Rizzo, School of Social Welfare, University at Albany SUNY
Walter Rosenberg, Social Work and Community Health, Rush University Medical Center
Loel Solomon, Kaiser Permanente National Community Benefit
Laura Taylor, Veterans Health Administration, U.S. Department of Veterans Affairs
Roberta Waite, College of Nursing and Health Professions, Drexel University and Stephen and Sandra Sheller 11th Street Family Health Service
Michelle M. Washko, National Center for Health Workforce Analysis, Health Resources and Services Administration, U.S. Department of Health and Human Services
Randi Woods, Sisters Together and Reaching, Inc.
We also thank Dave Chokshi, NYC Health + Hospitals, and Louise Cohen and Riley Moreen, Primary Care Development Corporation, for providing information to the committee at its request.
We appreciate the considerable efforts of Bonnie Ewald, Rush University Medical Center, and of the Social Work in Health Care Leadership Workgroup convened by the Center for Health and Social Care Integration, who were instrumental in conceiving the idea for the study and working to move it forward. In addition to the study staff, we would like to thank National Academies’ staff members Daniel Bearss1 and Jorge Mendoza-Torres for their research assistance, Kyra Cappelucci and Greta Gorman for their oversight of report communications efforts, and Karen Helsing for her assistance with fundraising for the study.
___________________
1 Daniel Bearss passed away on July 5, 2019. A senior librarian at the National Academies since 2005, his assistance with literature searches and other research for this report was invaluable.
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