Social Worker I - Masters - Transitions Coordinator

at  Providence Healthcare

ARTICLE FLAG: MANDATORY VACCINATION PLEASE NOTE:

As per the current Public Health Orders (Long Term Care/Seniors Assisted Living Provincial Health Order and the Health Sector Order), as of October 26, 2021, all employees working for Providence Health Care must be fully vaccinated against COVID-19. Proof of vaccination status will be required.
Summary: Within the context of a patient, client and family centred model of care and, in accordance with the Mission, Vision and Values, and strategic directions of Providence Health Care, promotes a safe, respectful, and civil working environment for patients, residents, families, visitors and staff.
Reporting to the designated Social Work Site Leader and receiving guidance and support from the Professional Practice Leader and/or Research, Education and Practice Coordinator, the position supports the interdisciplinary program/team, which is under the direction of the Operations Leader, in achieving program, patient and resident goals. Provides consultative and direct services to patient/resident, families, staff and community health professionals regarding community resources and provides leadership to the interdisciplinary team in coordinating transitions within the program and to/from the community. Duties include providing therapeutic clinical counseling and group facilitation services, conducting comprehensive biopsychosocial assessments and maintaining patient/resident records. Coordinates clinical/case conferences, develops and delivers in-services and presentations for staff, participates as a member of local committees and group meetings and maintains broad knowledge of developments in the Social Work profession.
Qualifications / Skills and Education: Education
Masters in Social Work from an accredited university. One year of recent related experience in the related clinical area, or an equivalent combination of education, training and experience. Current full registration with the British Columbia College of Social Workers.
Skills and Abilities
Demonstrated ability to communicate with and deal effectively with, patients/residents, families, staff, physicians, and other health care providers.
Knowledge of legislation and government policies and procedures related to healthcare.
Demonstrated ability to gather relevant data and make a biopsychosocial assessment.
Demonstrated ability to conduct patient/resident assessments.
Knowledge of other health care disciplines and their role in patient/resident care.
Demonstrated ability to draw out information that will contribute to understanding the patient/resident’s situation in order to explore issues beyond the identified initial concerns.
Demonstrated ability to work collaboratively as a member of an interdisciplinary team.
Demonstrated ability to deal with and/or guide others in conflict resolution issues.
Physical ability to carry out the duties of the position.
Ability to work independently and prioritize issues and workload.
Ability to operate related equipment.
Ability to participate in research.
Ability to facilitate groups.
Demonstrated ability to provide supervision and teaching to students.
Ability to facilitate and influence group and inter-group meetings, processes and decision making.
Broad knowledge of external agencies and community resources.
Broad knowledge of systems thinking as it is related to the social work process.
Duties and Responsibilities: In conjunction with the Clinical Nurse Leader and as a member of the interdisciplinary team, coordinates the intake, discharge and transition of patients/residents by screening, interviewing and assessing patients and identifying required services and resources. Provides therapeutic clinical counseling services and group facilitation to patients/residents, families and groups in designated program area by methods such as exploring the client’s present situation in order to identify problems, personal concerns and treatment objectives, facilitating change in coping styles, behaviors, attitudes and feelings, participating with patients/residents, families, community supports and interdisciplinary treatment teams to coordinate services, facilitating meetings and making referrals to appropriate resources.
Conducts comprehensive social work and psycho-social assessments in designated program area by methods such as interviewing the patient/resident and/or family, obtaining relevant information, gathering social data regarding the patient/resident’s family, environment, culture, living situation and financial status and interpreting the data to therapeutically impact the patient/resident’s and family’s coping abilities.
Maintains patient/resident records by methods such as documenting patient/resident assessments, charting patient/resident information, preparing progress notes and reports in accordance with established standards, and policies and procedures to meet regulatory requirements and documenting for future reference.
As a member of the interdisciplinary care team, coordinates the continuum of care within the designated program area from intake to discharge, by methods such as determining appropriate transitions plans, conducting psychosocial assessments, interviewing the patient/resident and/or family and assessing and determining care level, eligibility, appropriateness and type of service required. On patient/resident admission, arranges hospital/community interdisciplinary team meetings to ensure effective utilization of patient/resident resources and to develop and coordinate discharge or transition plans for patients/residents with complex needs. Authorizes community services for patients requiring outpatient services, facility placement, home support and adult daycare. Collaborates with hospital and community services to determine discharge or transition needs and alternate level of care for patients/residents to ensure effective utilization of patient/resident resources within the region.
Provides consultative and direct services to patient/resident, families, staff and community health professionals regarding community resources and access to these resources by methods such as identifying applicable resources including financial assistance, sharing available resource opportunities and suggesting contacts in order to facilitate optimal planning and transitions from/to community.
Coordinates clinical care team conferences as a member of the interdisciplinary care team for patient/resident reviews, admissions, discharges, and transition plans.
Provides on-going program evaluation through methods such as providing input from a social work perspective on a variety of care issues related to the patient/resident and program effectiveness to ensure appropriate and effective treatment of the patient/resident as they transition through the continuum of services.
Develops, coordinates and delivers in-services, presentations and/or training related to designated program for the staff in collaboration with other members of the interdisciplinary team by performing duties such as determining relevant content and required audiovisual/handout aids, conducting literature searches and planning and coordinating seminars.
Participates as a member of local committees by methods such as engaging in program/practice evaluation, identifying opportunities for change, identifying areas to enhance communication and collaboration between service providers, assessing available resources, analyzing outcomes and identifying areas for improved efficiency and effectiveness in service delivery to enhance patient/resident service within the program and to reduce service gaps in the community.
Facilitates/participates in group meetings by performing duties such as facilitating group, providing clinical counseling services and providing therapeutic and/or psycho-social education as required.
Maintains broad knowledge of developments in the Social Work profession by methods such as reviewing literature in specialty area, consulting with clinical and community experts within the field, and participating in professional development activities in order to evaluate clinical practice and to improve care through new practices.
Maintains a variety of records such as workload statistics by methods such as recording information into approved formats, collating data, analyzing trends, accounting for variances and recommending an action plan to the Professional Practice Leader, Social Work.
Develops research protocols and conducts approved social work interdisciplinary research and special projects in collaboration with appropriate personnel through methods such as identifying current trends/gaps in literature, writing research proposals/grant applications, following through with research methodology and disseminating research findings. Ensures clinical practices and protocols are consistent with current research findings.
Provides teaching and supervision to social work students as assigned by methods such as providing guidance and the opportunity to observe and take an active role in the treatment of social work patients/residents.
Performs other related duties as assigned

Please refer the Job description for details