Academic journal article Health and Social Work


Academic journal article Health and Social Work


Article excerpt

Traditionally, family physicians have been called on to handle the emotional problems of their patients. Their ability to address these concerns has been inconsistent. In hospital settings, where interdisciplinary teams are common, nonmedical professionals have been able to provide counseling services to patients. But this is a problem in private medical practices. This article presents a model for collaboration between family medical and clinical social work practice and describes a holistic approach for primary care practice.

Key words

clinical social work community health care family medicine interdisciplinary collaboration medical social work

Family physicians traditionally have been called on to handle the emotional problems of their patients. Today, with the pressures of working in a managed care environment, physician capacity for emotional support to patients may be limited. Collaboration between the disciplines of family medicine and clinical social work demonstrates the usefulness of a partnership for providing a holistic approach to patient care. This article reviews the literature on the unique fit between clinical social work and family medicine. Pioneer Valley Professionals (PVP) is presented as an example of an independent, community-based model providing mental health services in a family medical practice in a midsize, ethnically diverse, northeastern town. The majority of patients in the practice work in factory or service jobs and generally are not eligible for government subsidies. They have limited economic resources, often depend on the salaries of two people to meet expenses, and pay for services either through managed care healt h plans available through their places of employment or, in the case of elderly patients, through Medicare insurance.


Increased attention has been given to the integration of mental health and primary care medicine (Abramson & Mizrahi, 1996; Blount, 1998; Blount & Bayona, 1994; Mitchell & Haber, 1997). Family medicine, although it is a relatively new specialty in primary care, has become increasingly recognized in the current managed care environment (Bray & Rogers, 1997; McDaniel, 1995; McDaniel, Campbell, & Seaburn, 1990; McDaniel, Hepworth, & Doherty, 1992; Pace, Chaney, Mullins, & Olson, 1995; Rakel, 1995). There is evidence in the literature to suggest that despite the fact that a significant number of patients using family practitioners have mental health problems, the management of psychosocial problems in the context of a general medical practice often is neglected.

Furthermore, despite the number of patients presenting in general medical practices moderate levels of depression and anxiety, there are limited referrals or counseling sessions by physicians to address such problems. (For further discussion, see Blount, 1998; Bray & Rogers, 1997; Higgins, 1994; Katon et al., 1990; Kroenke & Mangelsdorff, 1989; Paulsen, 1997; Spitzer et al., 1995).

This lack of attention to the mental health of patients by primary care physicians may be the result of time constraints or lack of training in dealing with such problems (Dorwart, 1990; Magruder-Habib, Zung, & Feussner, 1990). Mental health care can add significant time to already busy schedules, and many health plans may not reimburse the practitioner for such care. Previously, physicians were paid for each unit of service rendered. This model was revised under recent capitated plans by which physicians increasingly are paid block amounts per month for office visits. In the fee-for-service payment system, volume is associated with increased revenue. Under the capitation system, revenue is earned when the care is negotiated on the basis of a predetermined amount of money per member per month for a defined population of enrollees. Sabin (1991) called this "population-oriented practice management" (p. …

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