Winter 2026 Issue

Health Care: At the Bedside and Beyond
By Amber Simpson, MBA-HCAD, MSW, LCSW-S
Social Work Today
Vol. 26 No. 1 P. 8

Reimagining Social Workers’ Role in Hospitals

Social workers in health care today often focus more on discharge planning than clinical care due to case management roles. But what if social workers could practice at the top of their licensure within acute medical hospitals? What if their specialized training in therapy, systems theory, and psychosocial assessment were integrated into daily hospital operations to improve outcomes?

Innovation. Patient-centered care. An idea. A dream. These are more than just concepts. They are the building blocks of meaningful change in health care. All transformative initiatives start somewhere. And often, that change begins when a social worker and a psychiatrist start asking how we can do better.

A Missed Opportunity for Healing
Let’s meet Patient X. A 45-year-old individual who has survived a self-inflicted gunshot wound to the head. After the trauma team stabilizes the immediate medical concerns, a psychiatric consult is placed. The psychiatry team evaluates the patient and recommends inpatient psychiatric hospitalization. However, there’s a common barrier. Patient X is too medically compromised for transfer. Instead, medication is prescribed, and the patient either waits for viable placement or is discharged home. Returning home means facing old stressors, now worsened by new medical and emotional challenges.

This cycle repeats itself across hospitals. Patients like X are caught in a system that prioritizes medical stabilization but often falls short in addressing their mental health needs. Their stories remain unheard. No one teaches them coping skills or helps them find meaning in their hospitalization. The system treats their wounds but not their pain.

An Innovative Partnership
Jeffrey Barr, MD, a consulting psychiatrist with UT Health Houston at Memorial Hermann Hospital TMC located in Houston, saw the gaps in care and envisioned something more for his patients. He proposed a more integrated model in which psychiatric patients would receive therapeutic interventions during their hospitalization, rather than postponing treatment until after discharge to an external facility.

For two years, I, a licensed clinical social worker (LCSW), had the privilege of providing therapy to inpatient psychiatric patients at Memorial Hermann Hospital TMC, working alongside Dr Barr, and a team of medical professionals. I had the autonomy to structure the therapeutic sessions, design workbooks and innovative solutions within hospital systems to address care gaps, enhance patient outcomes, lower costs, and support interdisciplinary education. My voice, a social work voice, was valued and uplifted within the team.

More Than Discharge Planning
Social workers are often mischaracterized as only responsible for discharge planning in the acute hospital setting. LCSWs bring a skill set that makes them uniquely equipped to meet the complex needs of hospital patients. Trained in therapy, systems theory, crisis intervention and psychosocial assessments, social workers are embedded in both the clinical and social dimensions of care. We are problem solvers and critical thinkers who understand that healing cannot be separated from the context in which a patient lives.

What sets social workers apart is our foundation of guiding principles such as the NASW Code of Ethics, which prioritizes the dignity and worth of every person, the importance of human relationships, and commitment to social justice. We are trained to walk into a room and see the full picture: trauma history, grief, caregiver dynamics, relationship discord, housing instability, lack of support, and internalized stigma. We don’t shy away from hard conversations; we lean into them with empathy, clarity, and purpose. We act.

From Surviving to Healing
Patient X is a 45-year-old individual who has survived a self-inflicted gunshot wound to the head. Now, the patient X treatment team has a LCSW, a therapist, and meets patient X right where they are—medically compromised, emotionally overwhelmed with sadness, anxiety, and fear. Patient X’s story is heard and valued at a detailed level. They are given the space to talk through the emotional weight behind the attempt and explore the stressors that led to it. Together, they begin to build a crisis management plan that is grounded in patient X’s own values. Almost daily visits include evidence-based practices of cognitive restructuring, emotional regulation skills, and meaning-making conversations that help patient X reconnect with a sense of purpose and hope. Over time, these visits start to become a place where patient X is looking forward to talking, reminded they are not alone, and able to become an active participant in intentional healing—knowing healing is possible.

With each visit, Patient X begins to build a toolbox of skills to carry into life after discharge. These are strategies they can use during moments of distress or uncertainty. The discharge plan extends beyond finding placement. It also includes follow-up care for therapy and psychiatry services. Their support system is also engaged in the discharge planning process. In this new model, Patient X doesn’t just survive their injury at the hospital, but they begin the work of healing, with mental health support integrated into their recovery from the start.

What Happens When Social Workers Lead
The results of the changes at Memorial Herman Hospital TMC were undeniable:

• Reduced Length of Stay: Integrating behavioral health services into the medical setting led to a reduction in inpatient length of stay.

• Optimized Psychiatric Care: Patients who engaged in therapy were less likely to require inpatient psychiatric hospitalization postdischarge. Comprehensive outpatient mental health services were arranged to support ongoing care.

• Crisis Intervention and Coping Strategies: Patients left the hospital with practical tools, such as cognitive restructuring techniques, mindfulness strategies, and safety planning—proven methods for reducing suicidal ideation and self-harm behaviors.

• Improved Treatment Buy-In: Many patients had never engaged in psychiatric care before. Integrating therapy within the medical setting reduced stigma, increased adherence to psychiatric medication, and encouraged follow-up care upon discharge.

Beyond patient care, this initiative also had a profound impact on medical education. Working with PGY-4 psychiatry and neurology residents, as well as medical students, we emphasized the power of a multidisciplinary approach. By observing the combined efficacy of therapy and medication, future physicians gained insights into treating mental health with a more comprehensive and patient-focused approach.

The Financial and Operational Case for Inpatient Psychiatry
One of the most common barriers to implementing hospital-based therapy is the misconception that it is not billable. There are recognized models where therapists can generate revenue through accurate coding and billing mechanisms:

• Medicare and Private Insurance Coverage: Many insurance plans, including Medicare, allow for inpatient therapy services under CPT codes for psychotherapy (eg, 90832, 90834, 90837, and 90839 for crisis therapy) when medically necessary.

• Behavioral Health Integration (BHI) Model: Hospitals can bill for therapy services under BHI using CPT codes 96156 (initial assessment), 96158 (30-minute therapy session), and 96159 (additional 15-minute increments). Medicare patients may require G0323, and therapists with billing privileges (eg, LCSWs) can serve as the BHI billing provider.

• Value-Based Care & Bundled Payments: Reducing length of stay and readmissions aligns with value-based payment models, where hospitals receive incentives for cost-effective, high-quality care.

Blueprint for Change
Hospitals don’t need a new building or a grant to do this work. They need to see social workers as smart business decisions. When allowed to practice at the top of their licensure, social workers improve outcomes, reduce admissions, support smoother transitions, and enhance patient satisfaction. That’s return on investment.

This model started with a simple question and willingness to try something different. Hospitals looking to replicate it can begin by identifying LCSWs already in their system and giving them space—both literally and professionally—to do the work they are trained to do. Pair that with leadership support and billing models, and innovation becomes both possible and sustainable.

Hospitals ready to take the first step can start small. Pilot a therapist-led intervention on one medical unit. Collect qualitative and quantitative feedback. Partner with psychiatry to identify consults that would benefit from integrated therapy. Start documenting not just what’s medically necessary but what’s emotionally meaningful. Innovation doesn’t require perfection. It requires intention, consistency, and a team willing to see social work as a clinical investment, not a courtesy. When hospitals lean into that shift, transformation begins.

A Call to Action
Hospital social workers should move beyond just discharge planning. Our training and licensure enable us to perform a wide range of services with expertise. We can lead innovations, partner with medical teams, and design programs that improve lives and reduce system strain.

This model began with a question: How can we start to heal all wounds, not just the visible ones in the hospital? It grew into a collaborative intervention that changed lives, educated future clinicians, and demonstrated that social workers can, and should, practice at the top of their licensure. Change begins when one voice speaks up in the room, one question challenges the standard approach, one team decides to do things differently.

Now, the question remains, who will be the next to champion this change?

— Amber Simpson, MBA-HCAD, MSW, LCSW-S, is the founder of Eunoia Wellness Counseling.