Definition, rationale, literature review, essential elements, process for implementation, social worker role
Three sections follow:
1. Background Material that provides the context for the topic
2. A suggested Practice Approach
3. A list of Supporting Material / References
Feedback welcome!
Background Material
The following information, unless referenced otherwise, is taken from the WHOWPR Toolkit (2022) on social prescribing.
What is social prescribing?
Social prescribing is a holistic approach to health care.It is not an intervention by itself, but a pathway that helps to address the patient’s needs through connecting patients to a range of non-clinical services in the community to improve health and wellbeing.It does not just treat symptoms but addresses the causes of symptoms.The actual ‘social prescriptions’ are specific to each community and care setting, but typically include services providing support in mental health, social inclusion, and financial and housing advice, as well activities promoting physical activity and creative self-expression.
In the most common model, primary care providers refer patients to ‘link workers’ who work with patients to identify social needs. These link workers then work with patients to co-design personalized plans to improve well-being, routinely follow up with patients to monitor their progress, and make use of behaviour change techniques.
The link worker model can be adapted for each unique context. For example, the link worker responsibilities could be fulfilled by existing staff such as social care workers, community workers and nurses, by an organization (for example, a community-based NGO), or a newly created position.
Why social prescribing?
Social prescribing builds on the evidence that addressing social determinants of health, such as socioeconomic status, social connectivity, housing and education. These are key to improving health outcomes.
One of the strengths of social prescribing lies in providing a link to services that in most cases are already available in communities, thus having a potential for providing significant impact at a relatively low cost. Studies have shown social prescribing may:
Provide long-term savings to the health system,
Reduce primary doctor care and emergency department service demand,
Reduce secondary care referrals,
Improve psychological wellbeing,
Reduce anxiety,
Increase perceived quality of life,
Reduce feelings of loneliness and social isolation,
Improve mental and physical health.
However quantitative findings supporting the above are mixed at present largely due to an absence of rigorous evaluation. A recent literature review by Surynski et al. (2020) summarises the research on social prescribing.
Social prescribing literature review
This section is taken from Zurynski et al. (2020) who examined six literature reviews and 24 empirical studies from publications between 2017 and 2019. Most of these studies originated in the UK, with some also from Ireland, the Netherlands and Spain.
Current literature on the impacts of social prescribing is mixed, with both positive and negative outcomes being reported. There are very few robust, well-designed long-term evaluations of the impacts of social prescribing on patients, on GPs and other health professionals, on link workers or navigators and community services and on health systems. On balance however, there are some promising reports showing significant improvements in patient wellbeing and community connections. Other studies have demonstrated positive behavioural changes in terms of increasing healthy eating and exercise. Reductions in anxiety and depression and increases in community engagement and feelings of empowerment, confidence for self-care and resilience to manage health and psychosocial problems have been reported.
Significant barriers to the implementation of social prescribing programs were identified and need to be addressed when planning future programs. These include barriers among GPs and other health professionals including lack of awareness of social prescribing programs, perception that referrals to social prescribing programs is not part of their role, lack of capacity and time to refer, and limited training in how to refer and who to refer for social prescribing.
Important enablers were identified. These include having appropriate supporting health and social care policy in place to provide legitimacy for the development, implementation and evaluation of future social prescribing programs. Developing clear common understandings among all stakeholders of social prescribing programs, their purpose and potential benefits will require education, networking and the development of governance structures and strong leadership from within the health and community sectors.
The role of the navigator (link worker) was viewed as a crucial enabler to the success of social prescribing programs; however, there was an enormous amount of variability in understanding of the navigator role which could range from a person in a purpose-built paid role working in the health system, to a volunteer working in a charity organisation or a community group, or it could be a purpose-built paid role working for another organisation.
Regardless of the variety of terms used to describe navigators/link workers their role in making social prescribing program work cannot be denied. They are the lynch-pins boundary-spanners that link the health, community and social care sectors together. Most importantly they support patients with social prescribing referrals, provide practical support in identifying and solving problems and build empowerment in patients. social prescribing programs that included designated, paid navigator/link-worker roles were viewed by patients and GPs and other HPs as more effective. These workers should be included as essential to any future social prescribing programs.
Implementing social prescribing is difficult given the concept is unlikely to be widely understood. Even in the UK where social prescribing has been implemented for at least the last 10 years, studies published in 2018 and 2019 reported a lack of awareness of social prescribing and a lack of recognition of social prescribing by GPs and other health professionals as being part of their role.
Who is social prescribing for?
Evidence indicates that, although social prescribing can benefit anyone, people with certain social determinants of health could benefit the most. These include people who live in poverty, have stresses in early life, experience unemployment or social exclusion and are more likely to have negative health outcomes, such as poorer mental health and chronic conditions. Populations that are most likely to benefit include:
People with chronic conditions
People who are lonely or socially isolated
People at a high risk of mental health illness
People who are vulnerable, e.g. because of their age or financial situation (WHOWPR, 2022).
Essential elements
WHOWPR suggest a seven-step process that will be outlined later. RAGCP and CHF (2020) suggest the following.
The seven-step process for implementation
WHOWPR (2022) suggest implementation of social prescribing involves several steps, but the order in which they are implemented may vary depending on the specific context and circumstances. It is a non-linear process and, based on feedback, may involve several variations to improve the model. It may be necessary to return to a previous step and make changes.
Key factors for successful implementation include:
A strong leadership team
High levels of motivation, enthusiasm and creativity among the implementation staff
Flexibility and ability to adapt
Strong collaboration between the health-care and social care sectors, the government, NGOs and private sector organizations, including insurance companies
Support from the high-level leadership.
The plan-do-study-act approach may be relevant for each of the seven steps in the social prescribing approach.
1. Conduct a situational analysis
A situational analysis will facilitate understanding of the local sociocultural context and help identify gaps between needs and service provision. It will include consultation/interviews with clinicians, patients, caregivers and community, as deemed appropriate. A patient needs survey may be appropriate. A table in the WHOWPR document provides a detailed checklist for this analysis under the headings: population, feasibility, network and stakeholders.
2. Assemble a core implementation team
A strong implementation team should be multidisciplinary and have expertise in engaging with different stakeholders. Ensuring diversity among the staff is strongly recommended, both in terms of the groups they represent, but also their age, ethnicity, gender, religious affiliation, physical and mental ability, and expertise. It is important to identify a project lead.
3. Develop an implementation plan
Once formed, the team will need to meet to agree on objectives and formulate a workplan. Suggestions about what to cover when planning program implementation are outlined in a table in the WHOWPR document. It will also be important to identify available financial resources.
4. Map out community resources
The community-based resources to which patients could be referred can be diverse. Typically, these are services that already exist in the community. However, available services should be assessed to ensure they meet minimum standards
5. Get everyone on board
Most commonly, the following three key groups need to be engaged and trained:
Health-care providers, who identify patients who are suitable for social prescribing and refer them to the link workers.
Social and voluntary sector organizations, who should have a shared understanding of social prescribing and be familiar with the referral process
Link workers, who should have a good understanding of the community they serve and can effectively and compassionately connect their patients with community resources that will meet their needs. Link workers could be nurses, caregivers, occupational therapists, social workers, community outreach workers, health promoters or community volunteers. Some of the services link workers can prescribe include financial support, housing support, lifelong learning, physical wellbeing (e.g. diet and exercise), artistic activities, social support, volunteering opportunities.
The key responsibilities of link workers include the following:
Meet the patients to identify their needs, goals and pathways to achieving their objectives.
Understand how the social determinants of health affect patients’ well-being.
Connect patients with community services and provide ongoing support.
Continuously forge new relationships and strengthen existing ones with social and voluntary sectors.
Work as a team and provide peer support to other link workers with the goal of collectively supporting the patients.
An ideal link worker:
listens actively and empathizes with the patient
communicates effectively
can foster trusting relationships
can build and grow community networks
is knowledgeable and passionate about addressing the social determinants of health
ideally has some experience of working with patients
can speak local languages and is sensitive to the local culture.
6. Link worker training
Link worker training may be offered online. However, it should also be complemented with a practicum that could be supervised by senior link workers, health professionals or community organizations. It should cover:
Overview of the social prescribing scheme
Social determinants for health
Communication skills
Using the social prescribing tools
Patient interview and assessment
Developing a personal wellbeing plan (see accompany slide)
Patient referral to community services
Patient referral back to health-care services
Patient follow-up
Connecting with the core implementation team
Self-care
7. Monitoring and evaluation
Monitoring involves routine assessment of the intervention to assess if targets are being achieved. It can involve tracking adherence by patients, monitoring impact on workers and organisations, and determining areas for improvement. Questions to use to monitor workers and organisations are included in the WHOWPR article.
Evaluation is episodic assessment to generate evidence to show if social prescribing is both effective and cost-effective. Evaluation includes formal surveys, focus group discussions and interviews with patients. Evaluation tools and questions to use with patients are included in the article.
Practice Approach
The role of the social workers in a social prescribing approach to healthcare would appear to be two-fold: as a link-worker or as a practitioner working in a specific area.
The role of the link worker is outlined in point five of the WHOWPR model outlined above. It appears quite similar to that of a case manager. That topic is covered in more detail in the “case management” post at https://www.thesocialworkgraduate.com/post/case-management
Areas where social workers could become involved as part of social prescribing include providing mental health support and/or social needs support, providing counselling in general including creative self-expression counselling, addressing educational, employment and physical activity needs, as well as supporting the elderly. In providing this support social workers will use a variety of practice models suited to the person they are supporting. Some common models that may be used include problem solving, task-centred practice, solution-focused practice, motivational interviewing, behavioural activation, positive psychology approaches, and stress management. These topics are also on the website and can be located via the contents button on the home page.
Those involved in a social prescribing team should strive to be an effective member of the team. The Editorial Team on the Indeed website (Indeed Editorial Team, 2013) offer the following qualities of an effective team player.
A team player is someone who prioritizes the goals of the team rather than just their interests. Team players often believe the best way to achieve personal success is to help their entire team succeed. They're often loyal, flexible and reliable professionals who prioritize their peers and the group over themselves, meaning they're willing to make personal sacrifices if it leads to a better outcome for everyone.
Six qualities of a team player
Many personal qualities contribute to you being a good team player, and some things you can strive for include:
Good listener Good listeners always pay attention to their team members' ideas and suggestions. Team players willing to listen can help the team become more cohesive and effective.
Adaptable Team players can fill whatever role they can to help. Team players aren't stubborn or selfish in assigning roles because they know focusing on themselves can decrease teamwork and lead to worse results.
Aware of others A team player is also willing to admit when someone else might complete a task more efficiently than they can. They're willing to ask for help from someone they know has more experience or a more specific set of skills.
Reliable A team player typically understands their behavior can affect the entire team. Because of this, they're careful to always complete their share of the work efficiently and promptly. A team player tries to fulfill their obligations and is careful to follow through on any promises.
Responsible Instead of attempting to pass some of their tasks off to a co-worker, team players work hard to ensure they're consistently completing their duties in the workplace.
Outgoing A team player volunteers to contribute their skills or expertise whenever it might benefit the team and take the initiative.
Ten traits team players commonly have
Open-minded: Being willing to understand new perspectives and admit when you're wrong can benefit the entire team and ensure there are no disagreements.
Active problem solver: Taking the initiative to troubleshoot any issues the team faces and being proactive about solving them can help reduce workflow delays and ensure the team meets its goals.
Positive: Keeping a positive outlook at work can influence others to do the same. This can make the workplace more enjoyable for everyone and improve collaboration.
Accountable: Taking responsibility for any mistakes you make and helping to fix them can help others on the team trust you more because it shows them you're committed to the overall mission.
Professional: Dressing, speaking and acting professionally can help encourage more positive, appropriate work behaviors, and it may make your supervisors and peers more willing to rely on you in a team.
Enjoy learning: Continuing to learn new skills or processes that you can share with your team can help everyone improve their work and complete it more efficiently.
Motivated: Remaining motivated and persuading others to do the same often benefits the team. It can improve accountability for everyone and help maintain productivity.
Empathetic: Understanding when other team members are experiencing an issue and responding respectfully and appropriately can make them respect you more and realize you're more focused on the team than yourself.
Resourceful: Effective team players can maximize their resources and contribute to teams effectively without relying on additional help or taking resources away from someone else.
Direct: Being a team player sometimes means telling other team members something they don't want to hear. Being direct, honest and professional with them may make them more understanding and willing to accept your feedback.
References / Supporting Material
(available on request)
Indeed Editorial Team. (2023). 16 Qualities of a Team Player. https://www.indeed.com/career-advice/career-development/qualities-of-a-team-player
RAGCP & CHF: Royal Australian College of General Practitioners & Consumers Health Forum of Australia. (2020). Social prescribing roundtable November 2019: Report. https://www.racgp.org.au/FSDEDEV/media/documents/RACGP/Advocacy/Social-prescribing-report-and-recommendation.pdf
WHOWPR: World Health Organisation Regional Office for the Western Pacific. (2022). A toolkit on how to implement social prescribing. https://www.who.int/publications/i/item/9789290619765
Zurynski, Y., Vedovi, A., & Smith, K.(2020).Social prescribing: A rapid literature review to inform primary care policy in Australia.https://healthsystemsustainability.com.au/wp-content/uploads/2020/08/sprapidreview_3-2-20_final.pdf