Care in context

Joe Merighi explores the role of medical social workers in improving health care outcomes

When associate professor Joseph Merighi started his social work career at St. Mary’s Hospital in San Francisco, he quickly realized that many members of the medical staff didn’t fully understand his job or professional training.

“Most people thought we only provided discharge planning or worked on getting insurance coverage in place,” Merighi says. “People had a general understanding of how we helped patients connect with a variety of services and community resources, but they didn’t understand how social workers were trained to intervene in psychosocial issues.”

Psychosocial issues are those that involve both psychological and social aspects of a person’s situation. They require that problems be resolved in the context of such factors as environment, culture, language, and policy. At the time, Merighi worked with HIV/AIDS patients and their caregivers, advocating for clients, completing psychosocial assessments, and doing mental health counseling in addition to discharge planning.

“It was a time when there were so many deaths,” he remembers. “Lots of emotional labor went into the work, professionally and personally.”

Merighi developed a strong and lasting interest in the evolving social work profession and in helping people navigate complex systems. His experience as a medical social worker became the foundation for an academic career that began in California and continued in Boston.

In 2013, Merighi came to Minnesota to join the School of Social Work. He was drawn by the strength and prominence of the University’s Academic Health Center and Mayo Hospitals and Clinics and the rich intellectual and research environment—a great place to pursue his interests in the psychosocial aspects of kidney disease.

The high stakes of kidney disease

Merighi’s research over the past decade has focused on renal social workers’ roles in health care settings—specifically end-stage renal disease, a stage of kidney failure that calls for dialysis or transplantation. It’s an area of practice for which Medicare regulations require a social worker with a master’s degree.

A relatively small number of the 47 million Medicare beneficiaries in 2011—about 507,000—had kidney failure and required dialysis or kidney transplantation, but care for this group accounted for about 6 percent of the total Medicare budget.

“I love hospitals, clinics, and health care settings—I’m excited by the work being done there. I enjoy learning and teaching about the importance of social context as a key influence on health outcomes.”

As with other chronic diseases, Merighi sees a unique role for social workers in assessing renal patients’ psychosocial health and promoting their abilities to help manage their own health. He is documenting through research the roles social workers play in end-stage renal disease care.

For example, social workers can help dialysis patients with low health literacy to understand the need to take pills as prescribed and to overcome the barriers to optimal medication self-management. Renal social workers are also trained to provide dialysis patients with clinical counseling.

But too often, they don’t have time. The Council of Nephrology Social Workers recommends a caseload of 75 patients for one full-time social worker, yet the average caseload for a full-time dialysis social worker at the beginning of 2014 was 113 patients.

Giving social workers the support and time they need to do their clinical work will improve patient outcomes and provide a better quality of life for patients, Merighi argues. He also aims to affect practice by educating the public and the health care community about the specialized knowledge and skills social workers bring to an interprofessional care team.

Another reason dialysis social work interests him is the for-profit nature of this area of health care.

“Many dialysis social workers are working in an environment driven by profit and the bottom line, which is not in concert with the values of social work,” Merighi says.

A path to social work

Growing up in rural New Jersey, Merighi thought he would become an engineer. He describes himself as a geek in high school. “I took a science course instead of lunch!” he says.

In college, he got the chance to study engineering for a year in France and discovered interests in philosophy, psychology, languages, and art history. When he returned, he finished with a double major in life science and psychology.

From there, he went on for a master’s degree in clinical psychology, then two years of research experience at Yale University before heading to California. By the time he completed his Ph.D., he had experienced the profession at the frontlines of a global health crisis.

“I didn’t know anything about social work until I was applying to the M.S.W. program at Berkeley,” says Merighi. “So it has been a combination of loving science and then working in the HIV/AIDS environment at that particular time that resulted in my becoming a medical social worker.”

As his first year in Minnesota came to an end, Merighi reflected on the rich experience of teaching research courses and supervising second-year M.S.W. students working in community-based agencies such as Children’s Hospital, Ramsey County, the Animal Humane Society, and an organization that teaches professionals how to conduct forensic interviews.

He is also looking ahead, excited to begin a  medication adherence study with dialysis patients in central Minnesota, and planning a new research project to examine the psychosocial needs of patients in cardiac rehabilitation.

Learn more about associate professor Joe Merighi and the School of Social Work. See also the original story published in the School of Social Work 2013 report, Research for the Common Good.

Adapted from a story by Joel Grostephan | June 2014