Mosaics, Fall 2015
When Medicine Met Social Work: Jennifer Carlson, MSW '94, introduces behavioral health to primary care
by Jim Bisco
Physicians and social workers have traditionally led separate working lives outside of hospital settings. While they're both human services providers, usually they've practiced in two different worlds until last November when they began working together in a large primary care setting in Tonawanda, N.Y.
Jennifer Carlson, director of clinical operations at the Sheridan Medical Group, has long championed the need for behavioral health to come under the primary care umbrella. It was a concept for which her social worker-psychologist father James MacKenzie, a UB alumnus (MSW '67, PhD, '78), advocated throughout his career while working in medical education.
Now its time has come. Even federal regulatory measures are encouraging this one-stop, whole health scenario.
The practice itself has leaned toward this concept since the physician partners left their HMO employer 12 years ago to hang out their own shingle. Now the Sheridan Medical Group is establishing a veritable health mall at their facility, with a fitness gym, physical therapy, dietary and now social work.
Behavioral health was introduced into the practice by using the Diagnostic and Severity Measure for Depression as the first step and as part of their patient-centered medical home accreditation. "It became apparent in the research that depression was a significant mitigating factor when you're trying to treat other chronic health conditions like diabetes and obesity, and the relationship is cyclical," Carlson explains. "If you have somebody who is struggling with depression, it's going to be very difficult to engage them in changing behavior that would improve their diabetes."
Historically, patients often bring issues to doctor appointments that have nothing to do with their medical care because it feels like a safe place with people they trust. Primary care support staff often develop close relationships with patients who share personal information, especially those with chronic conditions who visit the office regularly.
To determine the services that a patient might need and how to access them, the practice had to shepherd the process. Carlson began to arrange what she calls tea-and-biscuit meetings with administrators of social services agencies in the community. "They were just amazed that they were being invited into a medical setting where we wanted to know their opinions and what they needed from us so that our patients could benefit from their services," she says.
The behavioral health department that Carlson has been developing at the practice includes social worker Rob Schwartz, '77, and SSW graduate student Genevieve Gibson.
Schwartz, previously director of psychosocial support services at Hospice Buffalo where social workers are an integral part of an interdisciplinary team, notes that the patients appreciate the assistance provided for them in navigating what can be a very challenging process for accessing behavioral health services. "It has allowed providers to focus their attention on the patients’ medical issues while empowering them to connect patients with behavioral health and other social issues to the in-house social worker," he points out.
In the first year of operation at the practice, referrals have been made for general mental health issues, primarily anxiety and depression, and more serious psychiatric disorders such as schizophrenia, bipolar, domestic violence and suicidal risk. Quite a few are referred for bereavement concerns, as well as caregiver stress.
"I think it takes the position as a preventive model to address things before they become bigger problems. We thought the patients would benefit from this but I don't think we expected it to be quite as busy as it's been," says Richard Carlson, Jr., physician partner in the practice and Jennifer Carlson’s husband.
"When social issues are identified, providers know that they have an easily accessible support service for them and for the patients," adds fellow partner Rajiv Jain. "Many times we're literally just walking patients down the hall."
Jennifer Carlson's SSW experience has driven her dedication through the years, especially with becoming immersed more recently in the school's focus on trauma-informed care. Her goal is to eventually hand off some of her administrative duties and develop a small private practice at Sheridan in order to deliver direct counseling services — a notion, she says, that SSW Dean Nancy Smyth has often encouraged her to pursue.
For now, she is enthused with her role in placing social work into the primary care context, a move she describes as revolutionary but one in keeping with its roots in changing social systems to better meet the needs of its constituents. "And that's what medicine is doing," she says. "In my opinion, social workers are uniquely suited to helping medicine transform itself."