Social workers are recognized as having a key role in the successful implementation of team-based models of care. As the largest group of clinically trained mental health providers in the United States, social workers are critical to meeting the needs of the estimated 2 million previously uninsured adults who will receive behavioral health services, many through integrated care.

This project provided much needed information about the challenges confronted by social workers and the health care agencies in which they are employed. This project was co-led by the University of North Carolina-Chapel Hill (UNC) and the University of Michigan. While the many roles social workers might play in an integrated health care (IHC) setting are clear, how this actually works in practice is not. Therefore, this project addressed the following specific aims:

  1. Described how social workers are integrated into care teams and the roles social workers fill in IHC
  2. Investigated the needs and skill gaps of social workers in IHC setting and the ways in which they interacted with other health professionals on integrated teams
  3. Identified the challenges social workers face and the health care agencies in which they are employed to provide integrated services
  4. Identify how curricula and continuing professional opportunities can be modified to prepare social workers to work in new care delivery models


To deploy social workers in their fullest capacity, findings suggest that health systems will need continued support to implement integration elements in both hospital and across coordinated settings, such as community-based agencies.

Findings highlight the heterogeneity of social worker roles in different settings and suggest that many social workers’ functions may not be directly reimbursable in fee for service payment models. As social work continues employment in integrated settings, systems must prioritize appropriate billing protocols that support social work functions and roles. However, some skills regularly used by social workers in integrated settings (i.e. addressing patient social determinants of health), provide intrinsic value that is hard to measure. This type of indirect value renders the return on investment of the work of social workers in integrated settings difficult to define.

Further evidence is needed to quantify social work’s value in integrated health.


Toward a better understanding of social workers on integrated care teams

Policy Brief
Full Report



Lisa de Saxe Zerden, PhD, MSW
Erica Richman, PhD, MSW
Brianna Lombardi, MSW
Brian Perron, PhD