University of North Carolina at Chapel Hill School of Social Work Research Assistant Professor Brianna Lombardi investigates the social work workforce with an eye on integrated health care teams.
Her recent publication, “Varying Estimates of Social Workers in the United States: Which Data Source to Use?” published in the journal Medical Care Research and Review examines commonly used national data sources to assess the adequacy of the social work workforce. Having access to adequate social work workforce data helps researchers and policymakers make decisions on where resources should be allocated for understaffed positions, ensure that the workforce is representative of its community; and understand what workers need to be satisfied in their positions.
Traditionally, social workers have been seen as separate from more conventional positions in the health care workforce like doctors and nurses. Why are we seeing a shift in that viewpoint?
Social workers have worked to address health needs in communities since our field began. Now, there is growing recognition of the role of social work because people are paying more attention to the social determinants of health. There is increased awareness and understanding that social risk factors and behavioral health needs drive health outcomes, as well as impact quality and cost of health services. Social workers are trained to screen, assess and treat social and behavioral health needs and will increasingly play a larger role in health care as the field transforms to address whole person care.
Additionally, changes in where health care is administered — from traditional health care settings like hospitals to more modern settings like community-based clinics — have changed the health workforce system. What has the research shown about how this has affected the social work profession and workforce?
Although health care has not traditionally focused on partnering with community-based settings, social workers have long served important roles in community-based organizations that address health needs. Health systems are recognizing that to improve care and reduce costs, care needs to be community driven. Social work is primed to facilitate health systems focusing on communities. Social work has always been a “boundary spanning” workforce bridging the silos of health, behavioral and social service organizations.
Even though social workers are having a greater impact in the health care field, it has been a struggle to get a comprehensive view of the fields’ workforce outlook. What are some of the challenges your team identified in why past data sets have not fully captured the social work workforce?
Because social work is dynamic it makes us difficult to be counted like other health professions. A strength of social work is that we work across different types of health settings and fulfill multiple roles. Social workers work in primary care, hospice settings, cancer care clinics, community mental health, emergency departments, and many more places. At the same time, a social worker’s job title may vary based on the function the social worker is fulfilling on a health team. Social workers may be working under the job titles of behavioral health clinicians, care managers, care coordinators, care navigators, or discharge planners. Relatedly, social work is inclusive of bachelor’s level and graduate level degrees — which impacts the roles we are allowed to fulfill and the mechanisms that can be used to pay for our services. This variation makes us difficult to count!
Another challenge that complicates the social work workforce outlook is around titles. For starters, some people use the title ‘social worker’ but may not be trained as a social worker through formal education. Other times, someone might be called a different title, (i.e., a depression care specialist, care manager, or counselor), so it is unclear who is providing the intervention.
What are some of the potential consequences for not having complete and reliable data about the social work workforce?
I see three consequences of not having complete and reliable data about social workers:
- Lack of reliable data can lead to faulty workforce projections and policies. It is difficult to estimate if the social work workforce is in over or undersupply because we do not have a complete census of our profession. Workforces in undersupply are in a position to be supported by training grants to promote growth and entrance into the field. But, if social work is shown to be in oversupply, there may be less incentives or support from federal or state investments to expand the field.
- Lack of complete data impacts our ability to ensure the social work workforce represents the communities we are called to serve. Understanding the race, ethnicity, gender identity, language, background, generation status, and other characteristics of the social work workforce is critical to holding our field accountable to ensuring we represent the communities we serve. Having this information also allows us to identify strategies to more intentionally recruit and include members of communities where representation is inadequate.
- Lack of complete data makes it difficult to understand the well-being of individuals over the course of their career. Some estimate 60% of MSW holding individuals do not work in the role of a social worker. We have little information to understand how an individual’s career progresses, what types of roles and settings a social worker may work, and how this relates to retention. Without this data, it is difficult to know how to most successfully recruit and retain individuals in the workforce and improve issues around pay, flexibility and job satisfaction.
The study analyzes the existing data sources for the state of the social work workforce. What did this analysis tell you about the current usefulness of these data sets and do you have any recommendations for how there could be a more useful, singular data set in the future?
Each data source gives us a different view of the social work workforce and each data source could be useful to answer different questions. My recommendation would be for the field and for researchers to have a better understanding of what type of social worker may be included in each data source — as this will be critical for interpretation of findings. For example, as our paper notes, the Integrated Postsecondary Education Data System gives us information on the number of individuals graduating with a master’s or bachelor’s degree in social work. This information tells us the number of social work degree holders is growing! However, we cannot connect this data clearly to the types of jobs and settings social workers are taking. Similarly, we have information on the number of licensed social workers in the U.S. through the Association of Social Work Boards, however, this tells us little about the types of settings or roles licensed social workers are fulfilling.
Did you find any direct takeaways about the current and future state of the social work workforce? Is the field seeing a need for more social workers and in which areas of care did you see the most need?
I think it’s really difficult to make statements about the state of the social work workforce in its entirety — in part because we do not have a single data source that reflects the entire social work workforce. However, across all the data sources there is a clear indicator that the social work field is growing. It is a major step forward to be having these conversations and wanting to enumerate social work, like we do for other health professions, because we’re integral to our health and social systems broadly.
How do you hope this study helps those that develop data sources and those, like researchers and policymakers, who use these data sources in decision making?
My hope is that researchers and policymakers become judicious consumers of research dependent on their research needs and what they are trying to determine. The data source matters, and I hope policymakers, researchers and everyone involved in workforce issues pays attention to these nuanced data sources so we can make more accurate estimates and comparisons. It is important to have a critical eye on the data source before making decisions.
If there’s one thing you hope people take away from this study, what would it be?
Select the data source that will best help you answer your question. Our paper tried to really explain that each source has strengths and limitations. It is critical that social workers lead social work workforce studies and identify strategies to grow and strengthen our field.
Read the paper online in Medical Care Research and Review. School of Social Work Associate Professor Lisa de Saxe Zerden and UNC School of Medicine Associate Professor Erin P. Fraher were co-authors of the study.
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