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
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,"
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
"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
"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."