Blue Cross Report: Social Services Critical to Improving Health


In a new report by the Blue Cross Blue Shield Foundation, social, behavioral, and environmental factors are shown to determine a staggering 60% of one’s overall health. The report provides overwhelming support for increased investment in, and collaboration with, social services as a way of improving overall individual and community health.

The report’s key findings include:

-Providing housing support for low-income, high-need individuals can result in net savings due to reduced health care costs. The net savings range from $9,000 per person per year to nearly $30,000 per person per year for the Housing First model, a harm-reduction approach in which adults who are homeless and who have behavioral health conditions are provided supportive housing.

-Nutritional assistance for high-risk women, infants, and children as well as older adults and people with disabilities lowers infant mortality rates, improves birth weights, reduces nursing home admissions, and significantly lowers federal and state Medicaid costs.

-Vulnerable populations experience health gains when their care is coordinated across primary, specialty, behavioral, and social services and that hospitalizations and emergency department visits are demonstrably reduced.

-Partnerships between health care and social service providers, particularly housing service providers, have been effective in improving health outcomes in certain high-need populations.

-Income support programs, specifically the Earned Income Tax Credit (EITC) and Supplemental Security Income (SSI), were associated with better health outcomes for those individuals who qualify for such programs.

By attributing 60% of one’s health to social, behavioral, and environmental factors, Blue Cross Blue Shield is making known that social workers and social service programs are the key to improving the health of individuals and communities. The report opens the door for unprecedented collaboration between social workers and private sector health insurers, who can work together to address patient care as a whole unit.

The report adds to the increasing evidence that integrated healthcare is the future of care delivery. Integrated care involves primary care providers and behavioral/mental health providers working in unison to treat the whole patient. Social workers, who are trained in interdisciplinary collaboration, are uniquely qualified to serve in this capacity.

Most importantly, the message of the report is clear: achieving optimal health is impossible without increased investment in social service programs, especially for vulnerable populations. This provides a major opportunity to advocate on behalf of increased investment in programs that improve health while reducing healthcare costs. When one of the nation’s largest health insurers says that social service programs are critical to the health of our nation, policy makers will have to listen.

Educating the Social Workers as Consultant (8th and Final in Series)

The standard social work education curriculum has 5 areas of inquiry: Practice Methods, Policy, Ethics, Human Behavior in the Social Environment, and Social Research.  The social worker as consultant may organize these into two categories: Systems of Practice with Human Behavior and Social Mechanisms.

“Systems of Practice with Human Behavior” describes the systems level the social worker as consultant is hired to impact. The systems level can be individual, family, group, organization, or community. Often, the social worker as consultant is tasked with assessment of one or more systems and observation, intervention or evaluation of one or more systems.  The traditional social work education practice methods informed by human behavior in the social environment can be enhanced with coursework that specifically applies these concepts to behavior change, culture change, leadership, innovation, and mobilization.

“Social Mechanisms” describes the structures that may be used to engage systems at any level. The social worker as consultant utilizes social mechanisms to intentionally support change. Traditional research training can be enhanced with specific techniques for information gathering and sharing. Advanced research can draw on in-depth interviewing, demography, and crowd sourcing.  Traditional policy can be expanded to include skill practice in outlining cultural mechanism, comparative analysis, and case construction. Traditional ethics can be augmented to emphasize economic justice, financial capability, and collective promotion of social good.


Toward jump starting the inclusion of content that would prepare the social worker as consultant, I propose a group of competencies. Each competency organizes modules having both skills suitable for classroom practice and connected abilities to be demonstrated in the field. Successful completion of skill challenges, demonstration of the abilities, and articulation of professional ethics would comprise a portfolio of competence.

Social Entrepreneurship

This group of modules explores the concept of social good as a business strategy. It includes concepts of social development, social capital, and social economics. Each student will be expected to master the following skills:

  • Articulate the process of value creation in 4 different business models: Sole proprietorship, B-Corp, C-Corp, and Non-Profit
  • Outline a successful supply chain model complete with holons, nodes, partners, third parties and logistics.
  • Calculate the expected return on investments in market development that includes support for financial capability and asset building of potential customers.
  • Compose a plan for sustainable growth with attention to the long-term health and well-being of human resources.
  • Define mechanisms of venture capital and crowd funding.

Leadership & Culture Change

This group of modules explores the power of a leader to cast a vision, build supportive structures, train staff, inform stakeholders, and manage organizational culture. Each student will be expected to master the following skills:

  • Define leadership for intentional goal achievement in interpersonal, organizational and community contexts.
  • Identify key stakeholders in a change process along with methods to engage each stakeholder group.
  • Outline a competency-based approach to training and education including certification and continuing education.
  • Analyze the compile the learning orientations and change facilitating factors present within an organization.
  • Articulate a process for creating and maintaining a social change movement within a community.

Behavior Change & Influence

This group of modules explores the unique ability of social workers to engage in interpersonal relationships, promote dignity and worth of the person, influence self-sufficiency, and support sustainable behavioral health choices. Each student will be expected to master the following skills:

  • Define complex adaptive systems in the context of emergence, human nature, and the concept of individual will.
  • Operationally define human interaction as a control system.
  • Identify the biological, social, psychological, spiritual, and perception parameters representing individual inputs into Sociocybernetic systems.
  • Model institutional systems utilizing agent-based model techniques.
  • Identify institutional structures that promote, stabilize, and constrain human choice behavior.


Council on Social Work Education (CSWE) policy, state licensure requirements, and typical university operating procedures provide supportive mechanisms for the education of the social worker as consultant. The competency-based structure of the aforementioned modules is in line with CSWE’s own competency-based approach. In addition, CSWE has adopted the concept of “Field as Signature Pedagogy.” This means that field work is the important opportunity to demonstrate skill and assess ability.

State licensure boards require continuing education almost without exception. This mechanism provides an opportunity for social work programs to continue to educate their graduates beyond the confines of their traditional curricula. Content on the social worker as consultant and other specialized competencies can headline continuing education content.

Universities maintain connection with their alumni as a matter of sustainability, but also as a matter of service. As a long-standing institution, universities have unique reciprocal offerings for students. Offerings such as credibility, personal introduction, event hosting, grants management, and others can benefit all alumni including the social worker as consultant.

Field Work

Students are a built-in opportunity for collaboration and capacity recognition when they are connected to the school and practicing in agencies. Enhance campus-community partnerships. Construct a continuum of service learning from volunteerism through project-based learning, to field practicum. Identify and strengthen all collaborating agencies by training them on competency-based education tenets and practices. Track student service contributions including class assignments, service learning, and student government activities. Provide an individualized learning plan for each student—a plan that recognizes the individual career and competence goals of the student. Connect students in purposeful advising with faculty and field instructors.

I propose that schools of social work engage students early, from the sophomore year for undergraduates, first semester for graduates. Identify projects based on the expected skill level of students. For example:

  • First Year: Customer Support, Office Rapport and Data Entry
  • Second Year: Knowledge Management, Training Support, and Client Assistance (Navigation through Service System)
  • Third Year: Compliance Evaluation, Quality Assurance, and Staff Training
  • Fourth Year:  Caseload Management, Policy Drafting, Group Engagement
  • Graduate/Continuing Ed: Supervision, Consulting, Grant Writing

Organize the field supervision model as a consultancy involving field liaisons as consultants to advance the mission of the agencies with which they liaison. Graduate students who are already employed in an agency can refocus on innovation and leadership in order to keep their jobs while growing educationally and adhering to the requirements of CSWE.

Continuing Education

Many schools of social work recognize the opportunity and service represented in continuing education programs. Many collaborate with on-site centers or community organizations to provide the information that alumni desire. Many also provide certification programs or other credentialing. Still others provide courses or supports for licensure examinations.

An innovation would find schools developing centralized training data stores, compiling the information reported from the field, and informing new service opportunities. The repository can be enhanced through agency collaboration creating a knowledge base and training platform for social work practice. Association partners can provide certification and credentialing along with a pool of diverse members. Agencies provide the practice environments for evaluation and available clients for research. The school of social work provides capacity in the form of student and expertise in the form of faculty.

The result for staff and faculty is continuing practice experience, continuing education, and increased relevance in the classroom. The result for students is educational innovation, certification, and a solid ability to contribute to their alma mater as well as the social work profession. For agencies, the return includes increased capacity, research & evaluation services, and continuing education for staff. For associations, the benefit is in the form of increased membership and collaborative research opportunities.

Alumni Services

With little experience, you need connections. Schools of social work often leverage their alumni connections, credibility, and reputation for the benefit of graduates. An innovation would find institutions partnering with associations to provide applied education & practice, networking, and demography symposia that bring together current and former students, agencies, and funders to discuss approaches to community development. Similar to what a chamber of commerce does for local businesses, schools of social work can act as “chambers of social good.” The result is an intentional impact on the community and a boost for students attempting to engage in their communities of practice. Schools can engage with agency boards and offer student representation from among current students or graduates. This maintains relationships between schools of social work and community agencies, but it can also be a model for engaged service to the community.

Schools of social work can engage consistently with local and state governments to outline a clear path for social workers to enter politics and engage the larger political discussion. School-sponsored visits to Capitol Hill, local congressional offices, and city council meetings can provide students with context for what they are learning. School-sponsored “suppers with the state representative” or other such events can engage alumni and current students in important issues and reveal politics as less intimidating.

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