God bless licensed clinical social workers. They are special people with a special calling to help people who often have complex issues. They have been instrumental to our success in population health, and I don’t know what we would do without them.
Here to tell you more about the history of licensed clinical social workers at St. Luke’s, the amazing work that they do and their evolving role is St. Luke’s Communications Coordinator Alexis Bennett.
- David C. Pate, M.D., J.D.
Social workers have been part of the St. Luke’s team for half a century.
But their roles, and their numbers, tell the story of just how profoundly health care is changing.
Long gone are the days of a quick visit to the doctor, resulting in a prescription and care instructions. Patients want and need more from their health-care experience.
St. Luke’s social workers are working to ensure they get what they need, helping with everything from care plans to utility bills.
Since the 1970s, before care coordination was popularized, licensed clinical social workers (LCSWs) have been part of St. Luke’s MSTI care teams, managing resources and supporting patients to achieve their best health-care outcomes.
The mission hasn’t changed, but the work has shifted.
Now, social workers with broad and specialty skillsets can be found in every corner of the health system.
And they’re changing the very way that patients experience care.
In primary care, LCSWs were recently added to seven Treasure Valley clinics, with more to come. It’s not uncommon for a patient to visit a primary care provider for a routine visit or treatment for another condition and have secondary concerns that a social worker steps in to address. And since many St. Luke’s social workers have master’s degrees and advanced clinical licenses, they can take on mental health issues in clinical care settings.
“Depending on the clinic, the collaborative care team has an LCSW who can do brief counseling,” said St. Luke’s Health System Primary Care Medical Director Dr. Laura McGeorge.
“They’re embedded in the clinic. We can do warm hand-offs and say, ‘This person is really struggling with substance abuse,’ or ‘This person is struggling with depression.’”
They also help patients access resources that can otherwise be barriers to well-managed care, such as transportation through existing partnerships with local transit companies to get to and from appointments, healthy foods to manage chronic illnesses or money for gas cards and other needs. That support often comes through a patient assistance fund available to offset the costs of cancer care and for St. Luke’s Children’s Hospital patients; because the barriers to managing a chronic cardiac condition are equally insurmountable, a fund was recently created specifically for primary care clinics.
In 2015, social workers were integrated into McCall care teams to improve the success rate of behavioral health referrals.
Now, patients with behavioral health concerns can meet with an integrated behavioral health social worker for immediate low-level counseling or receive a recommendation for specialty behavioral health social work.
“It can be an intimidating thing, especially for people who haven’t dealt with specialty behavioral health,” said Jacob Wilson, St. Luke’s McCall manager of behavioral health. “Just having people to talk to right then is beneficial for patients.
“I’ve also had people I’ve talked to who decide that they don’t need specialty intervention at the time but come back a year and a half later with something else.”
By integrating social workers in the process, referral rates have improved and patients receive care immediately, rather than needing to make an appointment with an outpatient counselor.
Triage in acute settings has been improved as well.
At St. Luke’s Children’s Hospital, pediatric psychiatric patients who enter the hospital through the emergency department are transferred to the pediatric psych consult liaison team. There, they are seen by one of two psychiatric social workers on staff.
The team is modeled after an evidence-based program at Boston Children’s Hospital and was created as part of a departmental transformation. In the last year, two social workers and a psychiatrist have been added to manage the increased pediatric psychiatric caseload.
In 2016, St. Luke’s Children’s Hospital in Boise boarded and then placed or discharged 149 pediatric patients with psychiatric issues. In 2017, that number rose to 273; there is no sign the need will decrease, given a variety of documented demographic trends in rates of mental and behavioral health problems among young people, clinician shortages, gaps in the community safety net and other factors.
“Many of the patients that are seen in the emergency department that are determined to need inpatient psychiatric care will end up boarded on the pediatric medical floor,” St. Luke’s Children’s Hospital Psychiatric Social Worker Emily Baird said.
“The patients remain boarded there until a psychiatric bed opens in the community or until we determine the patient is safe to return home with resources.”
Baird and her colleague Cassidy Ray provide counseling and mental health services as they work to arrange discharge or placement. The approach has been so successful that the team has shortened the housed time of patients from nearly two weeks to a matter of days.
In non-acute settings, social workers play a similar role.
With one in seven women experiencing postpartum depression, according to the American Psychological Association, postpartum risk assessment, education and counseling have become standard in labor and delivery.
“Post-partum depression can escalate to post-partum psychosis,” said St. Luke’s Meridian Social Worker Lauri Corpus. “OBs let me know when their patients are at-risk or require additional resources.”
Corpus and others work to smooth the transition to parenthood. Through the vast network of resources and relationships the social workers have, patients get the help they need.
“One gal needed a crib, car seat, mental health counseling and legal services to deal with a strained relationship with the baby’s dad,” Corpus said.
“We don’t always know exactly which service is best, but we know how to find that information.”
Corpus also helps with Unique Families, a St. Luke’s program that helps non-traditional parents including adoptive, surrogate, incarcerated and refugee moms and families.
“The unique family program has been crucial to getting paperwork done ahead of time and ensuring that there’s a smooth transition,” Corpus said. “We try to have conversations with parents, other children in the family, and make sure everything needed gets checked off the list before baby comes.”
St. Luke’s social workers have become a community resource as well.
“We can all talk about social determinants of health,” said Michele Betts, St. Luke’s director of social work, “but our staff have spent hours with people who are there, living the risk factors we discuss.
“We’re in the trenches, talking to people.”
In Boise, St. Luke’s social workers met with city leaders and planners long before the 2018 opening of New Path, a housing and services program for homeless residents. Their understanding of needs and how they might be accommodated played a crucial role in the program’s design and execution.
They’ve also collaborated with Allumbaugh House and the Suicide Prevention Hotline, created vaccination clinics in rural communities, developed music-related therapies for memory-loss patients and much more.
For Betts, the evolving role only underscores what St. Luke’s has always done.
“St. Luke’s is still truly taking care of people,” Betts said. “We’re really committed to taking care of people.”
Alexis Bennett is a consultant for St. Luke's Community Health and Engagement.