The goal of this study was to obtain in-depth descriptions of barriers to primary care for adults with serious mental illness (SMI) and to provide solutions to these barriers. Qualitative interviews were administered to mental health and medical providers, as well as patients. Several major themes were reported including: poor access to care; patient limitations (e.g., psychopathology, cognitive difficulties); societal, health care system, and provider bias; integrated/fragmented care, communication difficulties; and quality of care issues. Results point to a need for nursing professionals to continue to improve access to medical care for this population, as well as to continue to integrate mental health and primary care.

This study examined how a rural setting impacts screening and treatment of metabolic syndrome (i.e., diabetes, cardiovascular disease, obesity) in adults with schizophrenia. Seven consumers with schizophrenia and metabolic syndrome, as well as 7 primary care and 7 psychiatric providers (21 total participants) from 2 rural communities, participated in semistructured qualitative interviews. Many barriers and facilitators to effective care were similar to those reported in urban environments. Issues unique to rural communities included fewer primary care providers willing to treat people with schizophrenia, fewer medical specialists, a lack of public transportation, geographic barriers, fewer financial resources, and high rates of unemployment and poverty. Strengths unique to rural communities included familiarity (between medical and mental health providers, and providers and patients), providers who were willing to “go the extra mile” for patients, many informal social supports, and the relaxed atmosphere of rural communities. Aside from financial and practical limitations, participants indicated that strategies to improve screening and treatment such as onsite phlebotomy and integrated primary care were feasible in rural communities. Addressing barriers that are common to urban and rural settings, as well as those that are unique to rural communities, is necessary to improve metabolic syndrome screening and treatment for this high risk population. Additionally, treatment models that build on the unique strengths of rural communities are most likely to be effective.

Implementation of evidence-based practices (EBP) in health and mental health settings has not been as successful as anticipated. Patients in safety net settings have even less opportunity to receive evidence-based care. Translation research has been dominated by efficacy trials, which often do not translate to the complexity of safety net settings. Implementation research to date seems to focus mostly on provider and organizational contextual factors more than macro and patient factors crucial to outcomes in safety net settings. Focus on translation and adaptation of interventions to safety net settings, and use of qualitative methods to flesh out complex processes and involve more stakeholders will help give safety net patients access to state of the art care. This issue is important for social workers to understand due to their ethical obligation to advocate for social justice and access to care for vulnerable and oppressed populations.

Introduction Although researchers develop evidence-based programs for public health practice, rates of adoption and implementation are often low. This qualitative study aimed to better understand implementation of the Program to Encourage Active, Rewarding Lives for Seniors (PEARLS), a depression care management program at a Seattle-King County area agency on aging.

The emergency department (ED) can be a critical intervention point for many patients with multifaceted needs. Social workers have long been part of interdisciplinary ED teams. This study aimed to contribute to the limited understanding of social worker-patient interactions and factors influencing social work services in this setting. This paper reports a qualitative content analysis of social work medical record notes (N=1,509) of services provided to trauma patients in an urban, public, level 1 trauma center and an in-depth analysis of semi-structured interviews with ED social workers (N=10). Eight major social work roles were identified: investigator, gatekeeper, resource broker, care coordinator, problem solver, crisis manager, advocate, discharge planner. Analyses revealed a complex interplay between ED social work services and multi-layered contexts. Using a social-ecological framework, we identified the interactions between micro or individual level factors, mezzo or local system level factors and macro environmental and systemic factors that play a role in ED interactions and patient services. Macro-level contextual influences were socio-structural forces including socioeconomic barriers to health, social hierarchies that reflected power differentials between providers and patients, and distrust or bias. Mezzo-level forces were limited resources, lack of healthcare system coordination, a challenging hierarchy within the medical model and the pressure to discharge patients quickly. Micro-level factors included characteristics of patients and social workers, complexity of patient stressors, empathic strain, lack of closure and compassion. All of these forces were at play in patient-social worker interactions and impacted service provision. Social workers were at times able to successfully navigate these forces, yet at other times these challenges were insurmountable. A conceptual model of ED social work and the influences on the patient-social worker interactions was developed to assist in guiding innovative research and practice models to improve services and outcomes in the complex, fast-paced ED.