The important role of social work in primary care

The staff at the Community Health Centre (CHC) where I work often discuss behavior change and the fact that many of our clients struggle to make changes that could affect the quality of their life. “If this client would only make some of the dietary changes as I’ve suggested…” “Despite all that we know about the dangers of smoking cigarettes, why do so many of our clients struggle to quit?”  Why are sustainable behaviour changes such a struggle for so many of our clients? Who can help?

Change is never easy.  Everyone struggles to make healthy decisions, and it can be enormously difficult to sustain these changes over the long term.  As a CHC, we serve many clients who live in poverty and face difficult life circumstances and deprivation, such as poor housing conditions, social isolation, stigma, and food insecurity. These conditions can lead to lives of high stress, chaos, instability, and de-motivation.   Choices are primarily made “in the moment”, often to help cope, with little thought or care to the long term consequences.  Sustainable behavior changes such as being more physically active, eating a balanced diet, and quitting smoking are not as likely to happen. The usual approaches to behavior change just won’t stick until deeper deprivation is addressed.

Most physicians have their hands full providing medical care, and so, despite concerns about their patients, have limited time to address their social needs outside of the office. Yet addressing these needs can very often make a significant difference in the health outcomes of a client.  A social worker is in an ideal position to offer the supportive counseling, social service referral assistance, and advocacy that many need to regain some stability in their lives.  In order for people to begin to truly focus on lifestyle behavior changes, they must have their basic physical and emotional needs met and a sense of solidity and control returned.

Physicians, social workers, and other health care professionals practicing together in a team-based model provide the ‘wrap around’ care that many patients truly need.  As an example, at our CHC  I provide smoke cessation counseling and refer certain clients to our social worker to address issues holding them back from quitting smoking, such as high stress, poor coping skills, isolation, and past trauma.  Demand has been so high that we now have two full time social workers on staff!

Social workers are integral members of inter-professional models of care (i.e. FHTs, CHCs), but unfortunately many patients cannot access these models of care in their community.  Only four percent of Ontario residents can currently access Community Health Centres.  Another factor affecting general access to social workers is that many work in private practice, so clients with no insurance often do not have the means to pay.  An expansion of collaborative primary care that includes social work is key to creating a healthier population.