Rethinking Caseloads in Sickle Cell Disease Social Work

Background

Sickle cell disease, a lifelong inherited condition affecting mostly African Americans, presents multilayered psychosocial challenges affiliated with systemic health inequities and social determinants of health.¹ With the strata of psychological, social, and vocational issues that accompany this pain-filled illness, social workers at the National Alliance of Sickle Cell Centers (NASCC) 2022 meeting voiced their concern about administrative and physician lack of clarity regarding their role, varied licensures, expertise, and capacity to cover caseload expectations.² To illustrate this misunderstanding in reality, a benchmark survey endorsed by the National Alliance of Sickle Cell Centers was distributed to psychosocial providers and social workers of differing qualifications to gather their reported caseloads per year.

Methodology

A NASCC-endorsed survey was distributed to psychosocial provider contacts in the organization's database. Providers of all sickle cell center sizes, from 100 to 800 + patients, were asked to indicate their role and caseload number. Free text boxes were provided for respondents to expand if necessary. Responses from social work and licensed clinical social work roles were filtered from the data using SPSS t-test statistical analysis.

Results

Of the forty social workers (MSW, CSW, LCSW, etc.) who responded to the survey, thirty-one gave a caseload number and nine either didn't answer or were unsure. The range of caseload numbers provided varied greatly (3 minimum to 600 maximum). The mean for nineteen master level social workers (MSW, MSSW, CSW, ASW, LSW, LBSW, LMSW) was 180 caseloads with a Standard Deviation of +/- 151. For the twelve licensed clinical social workers who responded, the mean was 194 with Standard Deviation of +/- 148.

Conclusion

These results are the first to represent perspectives of the social work workforce in the sickle cell space. No significant differentiation in caseload number exists across scope of practice and credentials. Lack of comprehension of the bandwidth needed across psychosocial roles to address the complex needs of patients with sickle cell disease is evident through the voices of those overworked in this field.

Johnson:Pfizer: Consultancy. Smith:Vertex: Honoraria; Pfizer: Consultancy.