Social Work and Health Care Practice and Policy: A Psychosocial Research Agenda

Abstract

It has been almost 15 years since social work researcher Rosalie Kane (1982) accurately predicted many of the changes occurring in health care today. Observing that social work had no monopoly on concern for the whole person and for the psychosocial well-being and quality of life of the individual, Kane also predicted that psychosocial research would influence health care decision making, that researchers from other professions and disciplines would conduct basic and applied psychosocial research, and that social workers would have to live with the results. Cautioning that research by others might fail to address problems and services of particular concern to social workers, Kane called on social work to empirically examine its practice by specifying the interventions and outcomes of social work services. In recent years, research on social and psychological factors and health has matured into a broad and increasingly respected science. Striking advances have been made in methodologies, and hybrid disciplines (for example, psychoneuroimmunology) have emerged that reflect critical linkages among biological, social, and psychological factors. Barriers to conducting large-scale controlled studies of psychosocial interventions are being surmounted. For example, the National Heart, Lung, and Blood Institute is currently conducting a four-year, multisite clinical trial of a psychosocial intervention among 3,000 post-heart attack patients. At the same time, policymakers' concerns about the cost, quality, and outcomes of health care have spawned the area of health services research, including effectiveness research and the RAND Medical Outcomes Study (Roper, Winkenwerder, Hackbarth, & Krakauer, 1988; Stewart et al., 1989; Wells, Burnam, & Camp., 1995). As a result, increasingly sophisticated services research methodologies and outcome measurement (Ware & Sherbourne, 1992) are being developed that can be applied to studies of the delivery of psychosocial services in real-world health care systems (Narrow, Regier, Rae, Manderscheid, & Locke, 1993; Regier et al., 1993; Sharfstein, Stoline, & Goldman, 1993; Taube, Mechanic, & Hohmann, 1989). Since Kane's (1982) call for increased social work research, social work contributions to the growing body of health-related psychosocial and services research have increased significantly. Indeed, social work researchers have produced two of the leading studies in mental health research (Hogarty et al., 1986; Test & Stein, 1980). Social workers are also increasing research on behavioral and supportive group interventions for patients with life-threatening physical illness (Evans & Connis, 1995; Subramanian, 1990; Toseland, Blanchard, & McCallion, 1995). However, the majority of studies have been conducted by researchers from other professions and disciplines. This article addresses the question, What are the implications of extant psychosocial health-related research for a future social work research agenda? In focusing on next steps for social work research, emphasis is given to gaps in the existing research on basic psychosocial research, psychosocial treatment and intervention research, and health services research (including managed care, outcome and quality of care, and intervention effectiveness research). The examples cited have been brought to the attention of the Institute for the Advancement of Social Work Research (IASWR) and are among the current priorities of national research funding organizations. The article concludes with recommended actions to increase social work's use of and contributions to the development of empirically based knowledge for health care practice and policy. Basic Psychosocial Research An extensive body of research documents the profound effects of behavioral and social factors on the etiology, course, and management of illness (Anderson & Armstead, 1995; Berkman, 1995; Kaplan, 1995; Kiecolt-Glaser & Glaser, 1995; Manuck, Marsland, Kaplan, & Williams, 1995; Scheier & Bridges, 1995). …