Social Workers and Health Promotion Interventions

Social workers can provide

1. Health promotional interventions, including couple and family counseling and self-help and mutual aid groups, to encourage lifestyle changes in amenable clients.

2. These social work interventions may became critical components when client became anxious when their elevated blood pressure remained unchanged.

3. health provider availability on an as-needed basis to consult with social workers for clients with dangerously elevated readings, and to re-assess and refer clients who may need emergency medical treatment. It might also be established that this health provider will also visit the agency on a periodic basis to provide follow-up assessment and confirmation of blood pressures, medical advice, and arrangements for medical appointments to clients who have not attended follow-up medical appointments, including referrals arranged by the social worker, or who remain anxious about their blood pressure.

4. social work clients may avoid or delay initial contact with health providers until they become aware that they have a condition that requires medical treatment; this resistance may be related to factors such as illness denial, fear of medical providers, and financial or health insurance concerns. The coupling of blood pressure monitoring within the context of trusting relationships between social workers and clients, in which stressful psychosocial, familial, and illness dynamics of their lives can be integrated and meaningfully addressed, may encourage clients to conduct their own blood pressure screenings, under the direction of social workers.

5. Clients with sustained elevated readings may then be more willing to follow through on medical referrals arranged by social workers or provided by a health provider on the premises of social service agencies. This programmatic design reflects features of transdisciplinary care that are valued by grant funders and the medical community:

6 social workers may be well-positioned to present other research findings—for example, if a social worker explains the linkage of high blood pressure to African Americans —this might be particularly effective in challenging denial and motivating adults and their adult children to improve adherence to hypertension medication regimens and lifestyle changes.

7. individual, couple, family, and group interventions for hypertension screening, motivational interviewing (a counseling intervention to encourage exploration and resolve ambivalence), stress reduction, behavior modification, psychoeducation, and illness self-management. [Motivational interviewing, for instance, has been shown to improve blood pressure among persons anticipating coronary artery bypass surgery (McHugh et al., 2001)].

8. The demonstrated efficacy of self-management programs suggests that “assisted-management” programs (i.e., with social workers engaging clients who cannot follow self-management programs on their own) could also be efficacious, and moreover, that assisted-management programs may be a means through which agency- based social workers serving numerous clients can move the community toward urgently needed improvement in our health care system. Some programming components may need to be targeted to specific populations—such as heavy smokers, those with co-occurring diabetes, frail elders with multiple illness conditions, or individuals diagnosed with severe mental illness —while others may serve broader populations simultaneously.

Good place here to tie in a communication theory

9. Routine blood pressure self-monitoring at home is also recommended for individuals with coronary heart disease or suspected nonadherence , and demonstration projects of social work hypertension screening in these groups are also warranted. Hypertension screening by social workers and other health providers may provide the only access to blood pressure self-monitoring devices by those who are poor, uninsured, isolated, or frail, and by disadvantaged minority and other underserved populations

10. Contributing factors are that some individuals will not adhere to using home devices as intended, and the general lack of reimbursement to individuals who purchase home blood pressure devices (Pickering et al., 2008).
In the current economic crisis, hypertension control and management is bound to deteriorate, especially given the rapidly growing population of employed and unemployed workers without health insurance. It may seem paradoxical, but given this new economic reality, there may now be greater receptivity among public and private funders that community social service agencies should be involved in screening, managing, and triaging clients with uncontrolled hypertension in order to avert much more expensive acute medical events requiring hospitalization.

11. Social workers are arguably among the best positioned professionals to assess and intervene “upstream” within the intrapsychic and psychosocial dynamics of individuals, couples, and family systems that precipitate and sustain high blood pressure, work against lasting lifestyle changes, and prevent adherence to hypertension medication regimens. Social workers attend as well to more conventional “downstream” barriers by serving as health educators and providing task-oriented and behavioral interventions, which could also include instructing clients in blood pressure self-screening and providing health care referrals for confirmation and follow-up care. There is untapped scope for social workers to integrate “upstream” and “downstream” approaches for more effective care.