With the Affordable Care Act and the changes in the DSM-V, social workers have a lot to keep up with in providing the latest information to our clients. The landscape of health care is changing by the minute, and these changes have implications no matter what setting you work in. The U.S Department of Health and Human Services definition of medical homes ” is not simply as a place but as a model of the organization of primary care that delivers the core functions of primary health care “. There are five main pillars which should be incorporated when developing models or programs for patient centered medical homes (PCMH).
1) Comprehensive Care
All mental and physical health will be handled under one umbrella where services will be provided for all aspects of physical and mental health while being able to communicate and share records. The hope would be that primary care, social work, nursing, psychologists, psychiatrists, and another specialist will make the best effort to offer the best care possible. We need to look at the whole person and not just in isolation.
2) Patient Centered
The aim is to help the patient make an informed decision. The goal of these decisions will be made not just by the doctor, but it will also be informed by the values of the patients. Social Work demands that we not only explore the patients values and ethics but also our own. If the patient is not already at the center of your practice than you might be doing something wrong.
3)Coordinated Care
The goal is to monitor and care for the patient no matter what level of care they are receiving. If someone is admitted to urgent care then someone from the primary care team would be involved at minimum through an Electronic Health Record. A nurse or case manager may ensure that the outpatient provider was aware. A similar process would take place in a longer inpatient stay with admission, treatment, and discharge being clearing communicated. Again, this is in line with looking at the whole person and with all those caring for them.
4) Accessibility
Ensuring that patient has 24 hour access to their care team. Social Work adds to the conversation about accessibility. I would expand this to mean equal access. If this model continues to be promoted , social work should be promoting this as well.
5) Quality and Safety
The aim to make sure that the services are of good quality, evidence based, and safe. Not only do we learn skills, participate, and develop programs, we also learn ways to assess them that incorporate all the above elements.
Where do we go from here?
In looking at the history of PCMH, it seems like a grassroots movement but in reverse. It has evolved out of various professional organizations developing the model to be implemented at both the state and federal level. States are being given federal dollars as an incentive to follow this model, and New York State has already adopted a similar model for adults and is currently developing a model for children.
It would benefit you to find out what your state is doing with the PCMH. Also for more info on PCMH and mental health check out The Advancing Integrated Mental Health Solutions (AIMS) Center at Washington University. For more youth specific resources The American Academy of Pediatrics has a Medical Home resource page. Seems like social work would be right at home within a medical home.
