About The Position

The Ambulatory Social Worker provides psychosocial support to patients with chronic disease through interdisciplinary collaboration, with the Palliative Medicine and Supportive Care team. Provides social work services to patients, families, and caregivers who have a life-threatening illness during a time of change and uncertainty associated with disability, loss and grief. Provides support for grief and bereavement services provided in the Palliative Medicine and Supportive Care (PM&SC).

Requirements

  • Experience in customer service.
  • Licensed Bachelor Social Worker - KSBSRB
  • Licensed Masters Social Worker - KSBSRB

Nice To Haves

  • Practicum experience or work experience in clinical setting dealing with families.
  • Experience in group work, case work, and community methodologies.
  • Advanced Certified Hospice & Palliative Care Social Worker (ACHP-SW) - NASW - Magnet

Responsibilities

  • Participates in patient admission process (Inpatient, Outpatient, PHP, IOP) a) assists as needed with signing of voluntary papers, b) serves as hospital representative and patient advocate.
  • Coordinates and facilitates services for patients and their families throughout the entire Stormont Vail Health system.
  • Performs social work assessments, demonstrating awareness of the bio-psychosocial, cultural, developmental and spiritual ramifications of illness and hospitalization.
  • Develops appropriate case management and/or treatment plan based upon assessment, client/family/caregiver specific concerns and recommendations of multidisciplinary care team.
  • Addresses patient/family/caregiver understanding of and adjustment to the illness, to maximize benefits of intervention and enhance patient/family/caregiver functioning.
  • Establishes supportive and therapeutic working relationship with patient/family/caregivers.
  • Communicates in a clear and concise manner with patients/families/caregivers regarding patient status and progress.
  • Evaluate and manage patient/family/caregivers psychosocial problems including conflict, isolation, treatment decisions, quality-of-life issues and transitions in care, advance directives, domestic violence, coping, anxiety, communication and functional changes.
  • Initiates discharge planning upon admission.
  • Is responsible for assuring these plans are coordinated with internal and external multidisciplinary teams and are implemented.
  • Initiates and develops long term planning designed to reduce recidivism, referrals are to be made as indicated
  • Maintains and modifies, as appropriate, the bereavement process for families of patients who die while under the care of PM&SC, This includes; o Providing telephone grief support interventions o Assessing need for a more formal bereavement service o Refer families to external bereavement support groups
  • Provides liaison function between Palliative care team and community hospice, home care agencies, long-term care facilities and other community services as needed to assist the patient to continue life in community or to learn to live within the limits of disability.
  • Participates in performance improvement initiatives.
  • Coordinates educational and outreach services relevant to the social/palliative care interface.
  • Provides liaison function between Palliative care team and hospital quality improvement, discharge planning, and external social service departments.
  • Provides problem solving and leadership in the development of new services which respond to patient care demands.
  • Maintains confidentiality and complies with professional ethics according to professional, departmental and Medical Center standards.
  • Actively participates and initiates when appropriate in patient care conferences.
  • Provide patient education regarding diagnosis and treatment.
  • Provide crisis and/or brief therapy for individual, family and group.
  • Assess patient and family functioning at time of discharge or referral to another provider.
  • Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health
  • Performs other duties as assigned
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