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Job title: Clinical Social Worker, Transitional Support
Company: WoodGreen Community Services
Job description: Employment Type:
Full-Time, Bargaining Unit
Work Hours:
35 hours/week
Salary:
External Rate: J7 – $57,800
Internal Rate: J8 – $58,980
Application Deadline:
Open until filled
Position Overview – Social Work, Community Care
This position acts as a Transitional Care Coordinator (TCC) for clients referred through the Virtual Hub. The program is responsible for supporting transitions from hospital to community for individuals living with complex mental health, addictions, health needs, and psychogeriatric concerns.
What You Will Do
Referrals and Outreach:
- Develop trust and rapport with clients and hospital staff in order to identify individuals who could benefit from social work support and transitional care coordination.
- Work with hospital staff to identify and engage clients and support hospital staff in making referrals through the Virtual Hub, as appropriate.
- Follow up with referral source(s) to learn more about the client being referred, reason for hospitalization, and/or reason for referral, to support development of Coordinated Care Plan.
- Develop relationships with other service providers in order to make seamless and effective referrals and service connections.
- Work closely with central intake and program managers to identify clients with frequent hospital/ED use who may benefit from Transitional Care Coordination.
Direct Client Support:
- Perform psychosocial and/or psychological and geriatric assessments.
- Provide service/care co-ordination, system navigation, short-term and long-term planning, and follow-up support.
- Provide short-term case management services (up to 90 days) to clients through the development and implementation of a care plan and/or Coordinated Care Plan to address their priority and emerging needs.
- Provide Transitional Care Coordination and work closely with Virtual Hub, hospitals, and other referral sources to support clients and facilitate transitions between hospital and community.
- Provide clinical and/or supportive counselling to clients utilizing a wide range of therapeutic approaches that best meet the clients’ needs and circumstances.
- Provide preliminary assessment of risk in crisis situations, consult and devise an intervention and action plan, and provide crisis intervention.
- Provide crisis intervention and practical assistance to clients and/or family or caregivers.
- Link clients with internal resources and external resources and programs.
- Work to prevent future avoidable ED visits, 30-day hospital re-admission, and Alternative Level of Care placements for clients referred through the Virtual Hub.
- Facilitate access to service including arranging phone/in-person interpretation when needed.
- In consultation with partners, develop appropriate onsite programming and supports.
- Facilitate or lead social and/or support groups.
TCC Virtual Hub Team Member:
- Provide suggestions, support, and resources to other TCCs and participate actively as part of the Virtual Hub team, sharing expertise.
- Manage all referrals accepted, including data collection/tracking.
- Discuss options for expanding referral sources while balancing TCC capacity and operational issues and offer recommendation to continue to develop Hub model.
General:
- Keep current about the range of services available in other agencies.
- Provide mentorship, training, and/or supervision to student placements and volunteers.
- Maintain appropriate records and documentation in a timely manner and collect statistical data required for the accountability of the program.
What You Bring to the Team
- Masters of Social Work (MSW) required.
- Registered Social Worker (RSW) in good standing with the Ontario College of Social Workers and Social Service Workers (OCSWSSW).
- Three (3) years of related experience in mental health, addictions, and/or social work.
- Demonstrated experience supporting individuals with significant mental health and/or addictions issues, cognitive impairment (e.g. dementia), and chronic health issues from a harm reduction, trauma informed, and mental health recovery approach is required.
- Ability to offer both virtual as well as in-person support.
What Will Set You Apart
- Demonstrated ability in supporting individuals who have complex mental health and/or addiction issues, geriatric issues, cognitive impairment, history of trauma, violence/abuse, chronic physical health issues, etc.
- Proven working knowledge of theories of addiction, evidence-based treatment models, and best practice approaches.
- Demonstrated ability in providing therapeutic and supportive counselling.
- Knowledge and experience providing addictions counselling and support.
- Proven ability in providing intensive and short-term case management, care coordination, and system navigation.
- Strong assessment skills, de-escalation, and crisis intervention skills.
- Strong interpersonal and conflict resolution skills.
- Excellent organizational and time management skills.
- Excellent oral and written communication and documentation skills.
- Self-directed and independent, but also proven experience in working effectively as a team member in collaboration with other community professionals.
- Ability to exercise good judgment and flexibility.
- Ability to work from a client-centred approach.
- Comprehensive understanding and knowledge of mental health, addictions, geriatrics, health sector, and community resources.
- Demonstrate knowledge of issues affecting marginalized communities, policies, legislation, programs, and other issues related to scope of practice and social determinants of health.
- Applied computer skills (MS word, Excel, Internet) and ability to use client information systems.
- Training and experience using InterRAI CHA, Pirouette, and ConnectingOntario is an asset.
- Proficiency in second language, written and oral, is a strong asset.
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Expected salary: $57800 per year
Location: Toronto, ON
Job date: Thu, 18 Feb 2021 02:06:05 GMT
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