Skip to Content

Innovations for Social Work in Primary Care By: Amanda Lazzarotti

Mr. Jones* is scheduled to meet with his family doctor today. He is 83 years old and has a history of hypertension, congestive heart failure, anxiety and depression. His health has declined since his wife of 55 years passed away 2 years ago. He lives by himself and is having trouble finding joy at home. He sits in the waiting room with his daughter who drove him to his appointment. Next to the receptionist desk, he notices a flyer that reads “Now a Patient-Centered Medical Home!” Mr. Jones is called in to see his doctor. After treating him medically, Mr. Jones’ doctor introduces him to the social worker at the office. Mr. Jones has never seen a social worker in his life and is surprised to see one now. The social worker explains that she is part of the patient-centered medical home and is available to help connect him with any community resources or support services.

Older adults may experience many transitions throughout the course of their lifetime, such as changes in personal care needs, social relationships and health. These changes can lead to repeated emergency department visits or hospitalizations, which can be stressful for individuals, families and the healthcare system. To address these challenges, some health care providers in New Jersey are seeking new ways to provide person-centered care that emphasizes the physical, mental and social aspects of the person. Some of these innovations involve social workers—a profession that has not been traditionally placed within primary care, but is increasingly present in healthcare to improve patients’ experience.

At Rutgers School of Social Work, students working towards their MSW Fellowship in Aging have the opportunity to engage in integrative field placements, such as primary care practices. Advocating for social work in primary care allows students to engage in leadership and professional development. This internship experience entails working as a member of an interdisciplinary team while promoting the importance of social work in this type of host setting.

The social worker can complement the medical care received by evaluating psychosocial factors (i.e., finances, social support, and mental health) that contribute to maintaining health and well-being and providing access to community resources that address those needs, such as Meals on Wheels, local Offices on Aging, prescription assistance, and behavioral health resources. Social work in healthcare settings provides opportunities for community and behavioral health services, offering a more comprehensive, person-centered treatment plan.

Social work professionals in the doctor’s office serve not only as a liaison to the community for patients and caregivers, but a support system that understands how mental, physical, and social well-being are interrelated. Social work in an outpatient medical setting supports and advocates for older adults to live independently and in their homes for as long as it is safe and medically possible. Older adults can focus on their health and other needs while remaining actively involved in the decision-making process with their family and healthcare provider. With all of the activity around improving healthcare delivery in New Jersey and beyond, there is a prevalent need for social work in primary care and interdisciplinary team approaches to service as an active voice for Mr. Jones and older adults, families and caregivers.

*Patient’s name has been changed

Back to top