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Determinants of Health Concentration Selection among University of Southern

California MSW Students Keyon R. M itch ell a n d D aw n M arie Joosten

By 2020, health care social workers are projected to make up 25 percent of the entire number o f professional social workers in the United States. At the University o f Southern California, the number o f graduate students selecting the health social work concentration has increased exponentially over the last five years. Although there are no published findings to indicate that other schools o f social work are experiencing a similar trend, the Bureau o f Labor Sta­ tistics has reported that, nationally, the number o f social workers employed in health care has increased and is projected to continue increasing over the next decade. The purpose o f this study was to identify decision-making determinants o f MSW students pursuing a specific vocational interest in health care settings. The study used a questionnaire to gather quantita­ tive and qualitative data from a population o f MSW students. The findings suggest that grad­ uate students select the health concentration based on self-knowledge (abilities and interests) and vocational knowledge (job demands and labor market). This article concludes with a discussion o f the implications o f these findings for health social work curriculums, practice, research, policy, and the integral role social workers play in health care reform in the present and will play in the future.

KEY WORDS: health care reform; health education; health labor force; health policy analysis

N ationally and internationally social w ork­ ers practice in an array o f settings, includ­ ing health care, nonprofit organizations,

consulting groups, and schools, to name a few. This article focuses on social workers interested in prac­ ticing in health care settings and provides a discus­ sion o f the impact social workers can have in health care in the U n ited States w ith specific regards to policy, research, and curriculum.

T he overall numberofsocial workers in th eU nited States is projected to increase gradually over the next decade. In contrast, the percentage o f social workers employed through health facilities is pro­ je c te d to experience a m ore dramatic increase o f 19.5 percent between 2008 and 2018 (U.S. Depart­ m ent o f Labor, Bureau o f Labor Statistics [DOL, BLS], n.d.-a). T o date, no research has been con­ ducted to examine reasons for this increase. This study aims to identify determinants o f health concentration selection am ong M SW students at the University o f Southern California (USC). Since 2007, the num ­ ber o f students that select the health concentration has experienced exponential growth, from 21 stu­ dents in 2006 to 110 in 2012 (see Figure 1).

LITERATURE REVIEW Health social w ork is a growing field. In 2008 social workers represented 1.4 percent o f the total health care workforce (DOL, BLS, n.d.-a). The D O L pre­ dicts that by 2020, the num ber o f health care social workers will increase by 34 percent and will make up 25 percent o f the entire num ber o f professional social workers (DOL, BLS, 2012). Understanding w hy graduate students select social w ork w ith a spe­ cific specialization in health care as a vocation can aid in national efforts to educate and attract m ore social workers to health care— although this con­ centration is already gaining in popularity, im ­ proving these efforts will ensure that there will be an adequate supply o f social workers w ith health care training to m eet the needs o f an additional 32 million patients insured under the Patient Pro­ tection and the Affordable Care Act o f 2010 (P.L. 111—148), com m only abbreviated as the ACA (DeParle, 2010). Identifying potential reasons for the increase in popularity is n ot only o f interest, but also necessary. As o f this writing, no research was found that provides reasons for the increase in health care social workers. However, Kerson, M cCoyd,

d o i: 10.1093/hsw/hlu033 © 2014 N a tional Association o f Social W orkers 230

Figure 1: Number of University of Southern California MSW Students Selecting Health

Concentration (2006-2013)

Year

and Associates (2010) have offered specific cases exemplifying the multifaceted role social workers play in health settings. Researchers have also noted that changes in health care places additional requirements on social workers to focus on clinical interventions, research, cultural com petency, and the ability to w ork w ith com plex cases (Browne, Smith, Ewalt, & Walker, 1996).

WORKING HYPOTHESES This study posed the following four research ques­ tions: (1) D o personal experiences influence M SW students’ selection o f the health care concentration? (2) D o M SW students select the health concentra­ tion because o f the growing older adult population? (3) D o M SW students select the health concentra­ tio n for jo b and financial security? (4) D o M SW students select the health concentration because o f interest in the ACA or health care reform in general? These questions were form ulated to improve our understanding o f w hy there has been an increase in the num ber o f M SW students seeking a vocation as health care social workers and o f the implications o f how health social workers may affect health care in the present and future.

Personal Experience The first hypothesis proposes that personal experi­ ences may influence vocational selection o f social workers in health care settings. Parson’s Career D evelopm ent Theory suggests that individual voca­ tional decision m aking is rationally inform ed by identifying a match betw een both self-knowledge (abilities and interest) and vocational know ledge (job demands and labor market) (National G uid­ ance Research Forum, 2012). Therefore, graduate students may select health social w ork as a vocation

because o f a match betw een personal interests and abilities and the know ledge o f the labor m arket and jo b specification. T he social w o rk profession has a unique set o f ideals detailed in N A SW ’s Code o f Ethics that emphasize service, social justice, dig­ nity and w orth o f the person, importance o f hum an relationships, integrity, and com petence (NASW, 2008). Consequently, a match betw een values from the Code o f Ethics w ith personal knowledge may also inform vocational decision making, resulting in a propensity and passion to w ork w ith individuals in health settings. Self-knowledge for health care interest may be inform ed by personal experiences that may include, b ut are n ot limited to, a previous experience o f being a medical patient or o f having a family m em ber w ith health issues. This study seeks to understand the role o f self-knowledge (abilities, personal experiences, and interests) in graduate student selection o f social work in health care as a vocation.

Growing Older Adult Population The second hypothesis offers the increase in geriat­ ric patients as one explanation for the projected grow th in social w orkers over the n ext decade. This hypothesis relates to vocational know ledge inherent in Parson’s Career D evelopm ent T heory (National Guidance Research Forum, 2012). Grad­ uate students w ho have a self-knowledge match for social w ork may select health care as a specialty in light o f understanding the labor market and subse­ quent health care needs o f a growing aging popula­ tion (National Guidance Research Forum, 2012). It is hypothesized that an increase in the num ber o f older adults may lead to an increase in social workers w ho desire to w ork in health care. O lder adults are projected to make up 19 percent o f the population by 2030 (U.S. Departm ent o f Health and H um an Services, 2012). W ith an increase in older adults, social workers practicing in health-related fields must becom e adept in palliative care, hospice care, and care o f chronic illnesses (Berkman, Gardner, Zodikoff, & H arootyan, 2006). T h e increase in the num ber o f older adults suggests that m ore jobs will be available to social workers in health settings (DOL, BLS, n.d.-a). Furthermore, Berkman, Gard­ ner, Zodikoff, and H arootyan (2005) emphasized that the social w o rk perspective can ensure that health care providers do n o t solely categorize older adults under the field o f gerontology. An integrated approach using a fram ew ork o f “biological, psy­ chological, socioenvironmental, cultural, political,

M itchell a n d Joosten / Determinants o f Health Concentration Selection among University o f Southern California M S W Students 2 3 1

and econom ic contexts” (Berkman et al., 2006, p. 204) must be used w hen assessing and treating older adults.

J o b a n d F in a n c ia l S e c u r ity T he third hypothesis for the increase in the num ber o f social workers is the desire for jo b and financial security. R etu rn in g to Parson’s Career D evelop­ m ent Theory, graduate students w ith a match be­ tw een self-knowledge (interest in social w ork and health) and vocational know ledge (awareness o f labor market) may base their vocational decision making on the proj ected jo b growth for social w ork­ ers in the health care sector. Job security and finan­ cial security do not mean the same thing; however, they are related. Job security refers to the ability to find and retain em ploym ent, whereas financial security describes how financial resources contribute to the maintenance o f one’s lifestyle. Although they are diiferent, they both can directly affect one’s finances. Students may be selecting the health con­ centration because o f the perception that employ­ m ent in a health setting is more secure. According to the U.S. News (2013), the most secure jobs are in the field o f health care. O n e o f the main areas affected by the recent Great Recession and subse­ quent economic dow nturn has been employment. As o f March 2012, the unem ploym ent rate for the U nited States was 8.2 percent (DOL, BLS, n.d.-b). The mean annual salary for individuals with at least a BSW was $42,480 in 2010, which was lower than the mean annual salary for BSW health social w ork­ ers at $45,582. The minimum requirement for social workers is a BSW; however, qualification require­ ments vary by agency, and according to the D O L, BLS (2014) an M SW is often required. In addition, some organizations require licensure for em ploy­ m ent in health settings that vary by state. In 2010, the mean annual salary for health social workers employed specifically in hospitals was $53,400. This salary was 25 percent higher than the mean annual salary for all social workers (DOL, BLS, 2014). Therefore, the desire for jo b and financial security may play a role in a social w ork student’s choice to w ork in health care.

In t e r e s t in H e a lt h C a re R e fo r m T h e fourth and final hypothesis suggests that the recent health care reform may have influenced M SW students’ selection o f the health concentra­ tion. Health care social workers provide assistance to

individuals and families during their most vulnera­ ble moments with services such as crisis intervention, needs assessments, palliative care, hospice care, and dealing w ith grief and loss (Berkman, 1996). Fur­ thermore, w ith the changing face o f health care pol­ icy in the U nited States, health social workers will be included in the continuum o f patient care from a political perspective as well (Gehlert & Brown, 2011). Social workers are n ot simply affected by health reform— they affect it as well. Zabora (2011) suggested that social workers must proactively en­ gage in preventing illness through the adoption o f evidence-based practices as well as creating and im­ plementing interventions that decrease health care costs.

T he passage o f the ACA is projected to reduce the num ber o f uninsured by 32 million (DeParle, 2010). Provisions w ithin the ACA increase access to preventive health care and aim to decrease health disparities through cultural competence training to providers in health care settings, increasing diversity w ithin the health care w orkforce and im proving research and data collection (W hite House, n.d.). Social workers aim to provide services to and advo­ cacy for underserved and vulnerable population groups. Graduate social w ork training emphasizes the needs for cultural competency. W ith the pas­ sage o f the ACA and im proved access to health care for patients from diverse backgrounds, social workers will be an integral part o f health care in the U nited States in capacities ranging from social services, curriculum, research, and policy (Gorin, G ehlert, & W ashington, 2010). W ith expertise and training in cultural competence, social workers in health care settings are in a unique position to provide leadership to ensure that cultural com pe­ tence trainings and workshops lead to im proved delivery o f culturally com petent care.

PURPOSE STATEMENT T he objective o f this study was to identify determi­ nants o f concentration selection am ong M SW stu­ dents at the U SC School o f Social W ork. T he USC School o f W ork curriculum offers a variety o f con­ centrations including health, mental health, families and children, w ork and life, and com m unity orga­ nizing planning and administration. In recent years, the n u m b er o f students selecting the health con­ centration increased dramatically. This study used m ixed m ethods to identify determ inants o f con­ centration selection. As suggested by R u b in and

232 H ealth & Social Work Volume 39, N umber 4 N ovember 2014

Babbie (2013), m ixed m ethods help determ ine how quantitative and qualitative data apply to par­ ticular studies.

METHOD

R e c ru itm e n t o f P a rtic ip a n ts Health concentration faculty members at the U SC School o f Social W ork were contacted prio r to administering the survey to ask for permission to visit classrooms to recruit study participants.

Students were recruited in tw o ways. T h e first m e th o d in clu d ed th e d istrib u tio n o f a p ap er questionnaire, w h ich was designed for th e p u r­ poses o f this study, to M S W students enrolled in five sections o f th e P rogram P lan n in g and Evaluation in H ealth Care course. T hese students had already b een enrolled in the health concen­ tration for one semester. A m ong 96 health co n ­ cen tratio n seco n d -y ear students, 76 co m p leted the questionnaire.

Because some o f the students interested in the health care concentration were n ot yet enrolled in any health concentration courses, a faculty advisor for the health concentration agreed to forward the questionnaire to them by e-mail (the e-mail con­ tained a link to the electronic version o f the ques­ tionnaire). O f the 110 students w ho were n o t yet enrolled in the health concentration, b u t w ould start the following semester, 35 students completed the questionnaire.

In fo r m e d C o n s e n t Participants in this study were invited to complete a questionnaire after receiving a consent form for nonm edical research previously approved by the U SC institutional review board. N o signatures were required to participate in this voluntary research study.

S a m p lin g T he sample size for this study included 111 M SW students. T w o different sampling strategies were used for this study. T he first sampling strategy was availability o r convenience sampling. W h e n the researchers visited the classrooms to distribute the w ritten questionnaire, students w ho were present and consented to the survey were provided a ques­ tionnaire. For the electronic version o f the ques­ tionnaire, students had the o p p o rtunity to view the consent form, and if they chose to participate, they w ere able to access the survey. All o f the

questionnaires com pleted in the classrooms and online are included in the study.

M e a s u re m e n ts T h e self-administered questionnaires w ere com ­ posed o f five closed-ended Likert-scale questions and eight o p en -en d ed short essay questions. T he Likert-scale items were measured from 1 to 4 (1 = strongly disagree, 2 = disagree, 3 = agree, and 4 = strongly agree). These items asked students to iden­ tify their preference from 1 to 4 for each question. All o f the questions covered topics such as personal experiences, older adults, health care reform, jo b security, and financial security. Students were allowed to choose w hat they most identified w ith through the Likert-scale items and had the oppor­ tu n ity to expand on their choices in the o pen- ended question responses.

DATA ANALYSIS

Q u a n tita tiv e Q u estio n s Descriptive statistics were generated using Excel. T h e closed-ended questions for each survey were entered into an Excel file. For each question, fre­ quencies and percentages were calculated for stu­ dents w ho strongly disagreed, disagreed, agreed, or strongly agreed w ith each question item. T he data were organized into frequency tables to categorize the numbers and percentages o f the responses.

Q u a lita tiv e D a ta Qualitative data analysis was done using the rapid approach, a strategy used w hen speed is a factor in generating results in a study w ith few questions and a clear focus (Krueger & Casey, 2000). Qualitative software analysis programs can be cosdy and require timely training. Given the short time frame o f one m onth to generate results from the time data were collected, using such a program was n o t feasible. After systematically random sampling every ninth survey, 12 surveys were used to identify qualitative themes. T w o raters analyzed each o f the 12 surveys o p en-ended questions independently and identi­ fied the most com m on themes for each question. Items o f agreem ent betw een the tw o raters were used to create categories for the most com m on themes. The other surveys were then examined to determine if the same themes were present. Themes were coded 1 = present on survey, 0 = not present on survey and were recorded usingExcel. Descriptive sta­ tistics were generated in Excel to report frequencies

M it c h e l l a n d J o o s t en / Determinants o f Health Concentration Selection among University o f Southern California M S W Students 2 3 3

and percentages for themes present for each open- ended question.

RESULTS Quantitative Findings Responses to the five closed-ended questions com ­ prise the quantitative data. For the breakdow n o f the findings, see Table 1.

Personal Experiences. This question was form u­ lated to find o u t w h eth er personal experiences affected their decision to choose the health concen­ tration. T h e results indicated that the majority o f the students (73 percent) either agreed or strongly agreed that personal experiences played a role in their decision.

Working with Older Adults. This question was formulated to find out w hether respondents wished to w ork w ith older adults. O f the 110 respondents, 51 percent did n ot select the health concentration to w o rk w ith older adults; the o th er 49 percent showed interest in w orking w ith older adults.

Job and Financial Security. These questions were form ulated to find o u t if respondents chose the health concentration because o f perceived jo b security and financial security, and findings showed that this was a case for the majority o f the students: 72 percent either agreed or strongly agreed that per­ ceived jo b security informed their decision to select the health concentration. Similarly, 71 percent o f the respondents either agreed o r strongly agreed that perceived financial security influenced their selection o f the health concentration.

Health Care Reform and th eA C A . This question was formulated to elicit w hether the ACA or inter­ est in the health care reform affected the students’ choice o f concentration. O f the 110 students w ho responded to this question, the majority (69 percent)

strongly disagreed o r disagreed that the ACA or health care reform influenced their decision.

Qualitative Findings Systematic random sampling was used to select 12 o ut o f the 111 questionnaires at random: Every ninth questionnaire was selected. T he most com m on themes were established based on the responses to open-ended questions in these 12 questionnaires. For each o f the open-ended questions, at least two themes were identified. Five o f the questions (ones discovered to provide valuable themes) are pre­ sented in Table 2.

Overall, the data include various qualitative themes, indicative o f a diversity in responses. However, the three themes with the highest percentages were the desire to w ork in a medical settings (48.4 percent), personal experiences (41.2 percent), and financial or jo b security (48.3 percent). The desire to w ork in a medical setting relates to Parson’s Career Develop­ ment Theory with respect to one’s interest in working in the medical field. Furthermore, these results sup­ port the hypothesis that personal experiences and jo b and financial security influenced concentration selection among the students in the study sample.

DISCUSSION Interpretation of Findings This study demonstrates, as suggested by Parson’s Career Development Theory, that graduate students at the U SC School o f Social W ork selected the health concentration for various personal (abilities and inter­ est) and vocational (job demands and labor market) reasons (National Guidance Research Forum, 2012). The quantitative results support the hypothesis that decision making was determined by personal experi­ ence, job security, and financial security.

aO ne stu d e n t d id n o t respond to this question. b14 students d id n o t respond t o this q uestion.

234 H ea lth d r Social Work Volume 39, N umber 4 N ovember 2014

T a b l e 2 : S t u d e n t D e t e r m i n a n t s o f H e a l t h

C o n c e n t r a t i o n S e l e c t i o n R e s p o n s e s t o C l o s e d - e n d e d Q u e s t i o n s (/V = 1 1 1 )

O p e n - e n d e d Q u e s t i o n a n d E m e r g e n t T h e m e s n (%) What influenced you to select the health

concentration? 111 Desire to work in a medical setting 47 (48.4) Financial security 11 (11.3) Personal experience 40 (41.2)

Are you interested in working with older adults (ages 65+)? Explain. 97 Gaps in service/needs 18 (18.5) Increasing population 12 (12.3)

In what ways has health care reform in the United States influenced your choice of the health concentration? 89 Desire to educate public 10 (11.2) More services and large impacts 19 (21.3) Job opportunities 11 (12.3)

What role did job security or financial security play in your decision to choose the health concentration? 93 Minor role 17 (18.2) Moderate role 14(15.0) Major role 45 (48.3)

Please list or describe any other reasons for choosing the health concentration? 67 Multidisciplinary team 5 (7.4) Growing older population 3 (4.4) Policy implications 5 (7.4)

A large propo rtio n o f M SW students reported that personal experiences influenced their choice for selecting the health concentration to pursue a career in the health care sector. For the purposes o f this study, the term “personal experience” relates to the concept o f self-knowledge outlined by Par­ son (National Guidance R esearch Forum , 2012). T h e results o f this study demonstrate that self- knowledge influences vocational decision m aking for graduate students to select health care as a spe­ cialization for social w ork practice.

Most graduate students also reported that jo b and financial security influenced their vocational deci­ sion making. Vocational decision making relates to another idea p ut forth by Parson, called vocational knowledge. This type o f knowledge is a reflection o f the labor and financial markets. As discussed earlier, job security and financial security are not completely independent concepts. Contextual factors to consider w hen interpreting these results include both tuition and unem ploym ent. This study surveyed graduate

students w hose tuitio n ranged from $40,000 to $50,000 annually. A bout 90 percent o f these stu­ dents receive financial aid in the form o f student loans, scholarships, work-study, and stipends (USC School o f Social W ork, 2012). T h e pressure o f repaying student loans is cause for students to seek a jo b that is financially secure and stable. It is w orth noting that the survey for this study was adminis­ tered in February 2012 w hen the unem ploym ent rate in California was 10.9 percent, significantly greater than the national average o f 8.3 percent (DOL, BLS, n.d.-b). These num bers serve as another motive for students to choose a profession that has better chances o f yielding a jo b . Overall, it is understandable that students pursuing graduate degrees w ere concerned about jo b security and financial security.

T he qualitative, open-ended items revealed that determ inants o f concentration selection for these students varied; however, there were similarities to the quantitative results. The main themes included the desire to w o rk in a medical setting; personal experiences; jo b and financial security; and the idea that, after ACA was to go into effect, more ser­ vices could result in larger impacts. As previously m entioned, the ACA is expected to increase access to health care for millions o f individuals and fami­ lies. To increase access to health care, health social workers will play an integral role in helping patients to understand the health care system; they will also advocate for patients to receive the health care ser­ vices available to th em (Jansson, 2011). Students w ho state that health care reform influenced their selection o f the health concentration cited not only job opportunities, b ut also the chance to educate the public and provide more services. These aspirations will affect the nature o f health care in this country. As proposed by Parson (National Guidance Research Forum, 2012), the results suggest that vocational deci­ sion making is indeed influenced by a match between self-knowledge and vocational knowledge.

L i m i t a t i o n s a n d I m p l i c a t i o n s f o r F u t u r e R e s e a r c h

This study was conducted at one graduate school o f social w ork in southern California. Therefore, the results may not be generalizable to graduate students at other universities in various geographical areas. Because this study did not collect demographic data on the students it is un k n o w n w h eth er responses varied by gender, age, or socioeconom ic status.

M itchell and J oosten / Determinants ofHealth Concentration Selection among University of Southern California MSW Students 235

Future research should survey graduate students from various demographic and geographical areas at multi­ ple academic institutions to determine whether they report similar self-knowledge and vocational knowl­ edge influences when choosing a career in the health care sector. In addition, future studies can examine the vocational motivations o f social workers already employed in health settings to provide insight into their vocational decision making and their role in a changing health care system.

Collection o f personal demographic information such as race, gender, and age could help researchers to examine w hether personal demographics influ­ ence vocational decision making for health concen­ tration selection. T he sample size for this study was small, and descriptive statistics were used to report all data. T he methods used to distribute the survey are one reason for the smaller sample size. T he distribu­ tion o f surveys directly in the classrooms presented as more effective because 76 students participated in the study, whereas only 35 students (a small percent­ age o f those contacted) participated in the online version. Future research should have a larger sample and use bivariate and multivariate analyses.

I m p l i c a t i o n s f o r C u r r i c u l u m , P r a c t ic e , a n d P o lic y Because o f the significant increase in social workers entering health settings, our research suggests that it is im portant for academic institutions to provide curriculums to students to develop the necessary skills to becom e effective practitioners in health set­ tings. O ver 20 years ago, Marshack, Davidson, and M izrahi (1988) conducted a study dem onstrating the gap b etw een w hat was learned in school and w hat was practiced in the field. This study was fol­ lowed by w o rk from Kadushin and Egan (1997), w hich further determ ined that m uch o f w hat was taught in social w ork schools did n ot match what was occurring in health care settings. T he concept o f health concentration in schools o f social works has b een evolving since its inception (Caroff & Mailik, 1985). Flowever, w ith an ever-changing health care system in the U nited States and future health social workers to train, it is imperative that curriculums m eet the needs o f students and profes­ sionals, w hich directly affect the needs o f patients. Presently, literature calls for courses geared toward the preparation o f M SW students for practicing in environments where health disparities exist (Mitch­ ell, 2012). In addition, a partnership betw een the

Council on Social W ork Education (CSWE) and the N ational Association o f Deans and D irectors o f Schools o f Social W ork is developing a curricu­ lum for training M SW students for clinical practice, policy, and health services to m eet the needs o f individuals in health settings (CSWE, n.d.).

Following the completion o f our study, faculty in the health concentration made curriculum m odifi­ cations to the health policy course. T he curriculum now ensured that student com petencies reflected policy relevant to direct practice in health settings through a m yriad o f federal-, state-, and county- level policies. T he curriculum emphasizes health care access, disparities, quality and safety, preventive care, mental health, ethics, professional standards, social service programs and eligibility criteria, safety net services, and health care reform. It also provides education on hom e and community-based services for lesbian, gay, bisexual, transgender, questioning; minority; female; child; older adult; homeless; and veteran populations. T h e m odified curriculum reinforces N A SW ’s Code of Ethics, w ith its emphasis on training health social w o rk students to serve individuals and families from various backgrounds (NASW, 2008). Effective social w o rk practice in health settings requires social workers to engage in practice informed by theory, evidence, and policy.

Furthermore, w ith the passage o f the ACA, social w orkers have the o p p o rtunity to becom e health policy advocates for older adults, uninsured patients, members o f m inority groups, undocum ented im­ migrants, and other vulnerable populations. These groups are often underserved and do n o t receive the necessary treatments they deserve. According to Jansson (2011), social workers as case advocates can w o rk in health care settings to address and advocate for policy changes at organizational, com ­ m unity, and legislative levels w h e n they observe any o f the following seven warning signs that health care consumers face w h en w orking w ith their patients: (1) inability to finance medical care, (2) poor-quality medical care, (3) ethical rights that are violated, (4) medical care that lacks cultural com petence, (5) lack o f access to preventive care, (6) untreated mental health needs, and (7) lack o f linkage to hom e and community-based services by health care providers. W ith the projected increase in the labor market for social workers in health care settings, social workers will continue to be key members o f multidisciplinary teams in health care settings. W ith specialized training as case advocates,

2 3 6 H ea lth & Social Work Volume 39, N umber 4 N ovember 2014

policy advocates, and clinicians, M SW social workers trained through health concentration programs and health courses will play an im portant role as health care reform continues its im plem entation. Social workers will be key advocates involved in reducing health disparities. T hey will improve access to preventive care, health insurance, social programs, and hom e and com m unity-based pro­ grams. Social workers will ensure that patients’ eth­ ical rights are n o t violated, and they will strive to enhance the quality o f life and well-being o f their patients. I5MVJ

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Keyon R . Mitchell, M S W , is a first-year medical student, V C Davis School o f Medicine, and member o f the tailored clinical track: Transforming Education and Community Health

fo r Medical Students (T E A C H -M S), 3962 1st Avenue, Sacramento, CA 95817; e-mail: [email protected]. Daum Marie Joosten, L C S W , P hD , is clinical associate pro­ fessor, School o f Social Work, University o f Southern California, Los Angeles.

O rig in a l m anuscript received December 10, 2012 Final revision received February 6, 2013 Accepted February 13, 2013 Advance Access Publication Septem ber 9, 2014

M itchell and Joosten / Determinants o f Health Concentration Selection among University o f Southern California M S W Students 2 3 7

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