Social work expertise: an overlooked opportunity for cutting-edge system design under the Patient Protection and Affordable Care Act.

Abstract

The signing of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) changed the landscape of health care in the United States. Embedded in this new policy direction are incentives to create a system that treats the whole person through the integration of behavioral and physical health—including substance use treatment. Social work expertise in these areas is crucial. How these changes are implemented will be critical for ensuring a system that meets the needs of people. It is vital that social workers gain a place at the table in health care system and policy discussions to ensure that best practices for integrative care are put in place as systems are designed. Changes at the macro level have a direct impact on what happens in the world of direct practice, and there will be key opportunities for social work reflected in new roles and a greater appreciation and expansion of long-standing practice endeavors. The incentives created in the ACA, both for integration of behavioral and physical health, as well as for more coordinated systems of care emphasizing awareness of social determinants of health (SDOH), are incentives that can be directly addressed through social work practice. The law proposes that these integrated care models move beyond the current environments, such as federally qualified health centers, to become more mainstream in the health care arena. Social work expertise in SDOH, care coordination and management, motivational interviewing, mental health, community resources, and other areas will be an asset to all integrated health care settings. If we as social workers do not assert our expertise as the system is redesigned, we will lose an important opportunity to help our clients and the profession of social work.