Darrell P. Wheeler
Continuing a history of inequity, private insurers have placed restrictions and limitations on coverage for mental health conditions making access to treatment services increasingly more challenging. A state-by-state advocacy movement has led to the enactment of various state laws to require mental health parity. With the Clinton Administration’s attempt at health care reform, mental health parity became part of the health reform debate and led to the passage of the Mental Health Parity Act of 1996. The inadequacies of this law were partially corrected in the Mental Health Parity and Addiction Equity Act of 2008, which included mandated coverage for substance use conditions. The Obama Administration in 2011 included these provisions in the Patient Protection and Affordable Care Act, which does not require compliance monitoring nor does it provide a definition for “mental health,” which leaves insurers to define it and hence determine what coverage will actually be available.
Shaun M. Eack
Mental health research is the study of the causes and correlates of mental health and illness, approaches to improve mental well-being, and the delivery of effective mental health services to those in need. Social workers have been leading researchers in each of these areas of inquiry, and this article provides an overview of the broad field of mental health research, with particular emphasis on the contributions of social work. A biopsychosocial review of research on the correlates of mental health and illness is provided, followed by a synthesis of studies examining pharmacological and psychosocial approaches to improving mental health. Research on mental health services is then presented, with a focus on studies seeking to improve access to quality care and reduce service disparities. Key directions for future mental health research include identifying specific causal predictors of mental illness, improving existing treatments, and disseminating advances to the community.
Jesse J. Harris, Col. USA Ret. and Kyle L. Pehrson, Col. USA Ret.
The history of military social work in the United States is rooted in the civilian professional social work community and is a microcosm of that sector. Military social work has a rich history of providing services to military men and women and their families during periods of peace, conflict, and national crises. They have been involved in humanitarian operations and have participated in multinational peace-keeping operations. Social work in the Army, Navy, and Air Force is tailored to the mission of their particular service. However, joint operations between the services are becoming more frequent. Military social workers adhere to the NASW code of ethics while providing service to an institution with its own unique culture, standards, and values.
Marie M. Lauria
Oncology social work is a specialization of social work in health care. Its practitioners provide supportive services and programs, patient navigation, education, research, administration, policy development, and advocacy to address the social, psychological, practical, and spiritual concerns of cancer patients, their families, and caregivers from pre-diagnosis through treatment, survivorship, and end of life care or bereavement. The coming decades will present many challenges and opportunities for oncology social workers in helping patients, families, and caregivers overcome barriers to quality of life and care.
Jennifer L. Magnabosco
Throughout history, measuring outcomes has been a goal and priority in the human services. This entry chronicles the history of outcomes measurement in the human services in the United States and discusses present-day outcome measurement activities as well as trends and some of the key areas for outcomes measurement in several human service domains.
Terry Altilio and Maris Pasquale Doran
Pain is a multidimensional, subjective experience that embodies the complex relationship of body, mind, emotions, and spirit. Assessment begins with the patient’s report and is enhanced by diagnostic tools, skilled inquiry and observation of behavioral, physical, cognitive and emotional responses. Pain may be acute, chronic, intermittent, or persistent and can be related to a chronic condition or progressive life-threatening illness—all of which may lead to significant psychological, spiritual, functional, and socioeconomic consequences. The undertreatment of pain is well documented and ubiquitous, especially in vulnerable populations, including the elderly, infants and children, and ethnic minorities. Inadequate management of pain has been the focus of national and international research and policy and relates to many variables, including the controversy and concerns about the use of opioids which are classified as controlled substances. This classification creates a unique environment of legislative, regulatory, and law enforcement scrutiny most recently exacerbated by the public health focus on the abuse of prescription medications. Pain is a clinical, ethical, policy, and advocacy issue. Advocating for state of the art pain management is a shared responsibility of professionals whose ethical codes include social justice, beneficence, and commitment to vulnerable populations.
Betty J. Kramer
Palliative care seeks to prevent and relieve suffering associated with serious illness for persons of all ages. The philosophical underpinnings of palliative care and the core elements of palliative care programs are described. The history of the hospice and palliative care movement, distinctions between hospice and palliative care programs and the roles and functions of social work in palliative care are reviewed. Contemporary issues that present challenges to the field that concerns the scope, focus, and intent of palliative care, the educational gaps in training of health-care professionals, the absence of a single social work leadership organization with a focus on palliative care, and the need to improve the quality and quantity of social work research are discussed.
Personalized health care (PHC) is a broad term that describes how we leverage our growing understanding of the human body and developing technology to provide more effective health care. PHC requires that health care providers consider prevention and treatment in the context of available advanced technologies, best practices, and known variables that define us as individuals. These variables or characteristics may run the gamut from genetic, to biologic, to environmental, to even personality, personal values, and choice. By considering how these characteristics interact with specific illnesses and available interventions, outcomes can be improved. The purpose of this article is to: describe PHC’s current conceptualization including relationship with personalized medicine and patient-centered models of care, discuss its development and application by specific stakeholders, and review pertinent economic, legislative, and ethical issues.
Rebecca S. Ashery
The passage of the Affordable Care Act (ACA) has injected new life into primary health care by establishing the primary care medical home (PCMH) as a cornerstone of health-care reform legislation. In addition to the PCMH, the ACA has a number of primary-care components that can open opportunities for social workers. Concerns remain for payment reform in the implementation of the PCMH. The implementation of the ACA is still a work in progress, with anticipated modifications and changes as issues arise.