Case Manager, Indigenous Mental Health

Detailed Overview

Utilizing the case management model and as part of a multidisciplinary team, the case manager provides clinical services to Indigenous clients in Community Programs, and works closely with other members of the clinical team in assessing clients' mental health and substance use status, formulating a plan of care, implementing planned care and evaluating outcomes.

The Case Manager works throughout the area in partnership with clients, caregivers, facility managers and staff of relevant community and regulatory agencies, and in partnership with First Nations Health Authority (FNHA);

participates in planning and developing mental health and substance use services; and provides community mental health and substance use education.

Responsibilities In consultation and collaboration with the local community, the case manager works to enhance, maintain, and / or develops new Indigenous mental health services;

organizes educational events as needed. Functions as a primary therapist and case manager, providing diagnostic client assessment and short and long term individual, group, and family mental health and concurrent disorder therapy, using a variety of interviewing, counselling, and assessment methods, in accordance with professional standards and clinical policies and practices.

Manages cases and formulates treatment plans and goals in conjunction with appropriate facility staff, including joint care plans with facility Managers of Care, assigned agency staff, and other services.

Uses crisis intervention and outreach as required. Facilitates clients' utilization of appropriate community services and rehabilitative programs by performing duties such as researching available services, liaising with these agencies, providing related advice and consultation to clients and providing referrals to appropriate community treatment alternatives and services.

Utilizes available community resources to develop supportive and rehabilitative programs for adults and their families. Makes arrangements for clients to be admitted to hospital when required, including on an involuntary basis.

Provides client care linkages between community mental health and substance use services and acute care facilities, including liaising with tertiary and acute care hospitals, and the Forensic Psychiatric Hospital to ensure appropriate referrals of clients and to facilitate assessment and care planning for client discharge from hospital.

Liaises with community outpatient clinics and treatment programs. Exchanges relevant client information and receives information about the status and background of clients who will be discharged or referred, in order to make necessary preparations for provision of a smooth continuum of care between acute care and community mental health and substance use services.

Assesses clients for placement to and discharge from care facilities, including specialized care licensed facilities, family care homes, congregate care homes and semi-independent living units, by determining eligibility, and type and level of care required.

Makes arrangements for client placement and care in care facilities by liaising with facility operators, placing client names on wait lists, assisting clients to make moving arrangements, and completing necessary referrals and forms.

Follows up with clients by visiting them at their accommodation and assessing the appropriateness of the facility and the level of care.

Adjusts placements as required. Provides support and direction to clients requiring enhanced case management by monitoring their mental health and substance use status, assessing their social adjustment and ability to perform routine life activities including managing money and taking medication regularly.

Provides follow-up care and services as required, including providing referrals to other healthcare professionals such as Recreational Therapists, Occupational Therapists, and Psychiatrists.

Updates the Clinical Coordinator on the status of client treatment and progress, as well as significant and unusual issues, developments, and circumstances.

Maintains client records and statistics, prepares reports, and completes forms as required, in accordance with Fraser Health policies and standards, including clinical record standards of Mental Health Services.

Obtains consent forms for release of client information. Advocates on behalf of clients, by performing duties such as providing clients with information about appeal processes, providing information about clients to relevant Ministries, and assisting clients to complete forms.

Acts as a resource for clients and their families. Provides education to clients, their families, and staff of care facilities and other agencies, regarding community mental health and substance use programs and issues.

Provides appropriate cultural educational material to staff of the local mental health centres, treatment and care facilities, and other agencies who work with Indigenous clients with mental health concerns.

Participates in quality improvement and risk management activities for assigned area by performing duties such as participating in quality initiatives, providing feedback to the Clinical Coordinator about needs and gaps in programs and services, and suggesting solutions and initiatives to assist in the development and maintenance of a coordinated mental health and substance use care system within the community.

Participates as a member of local committees and advisory boards to provide and receive information as a representative of the clinical team, as assigned.

Participates in clinical research and program evaluation activities relevant to the needs of clients, families, hospitals, and the community, by providing information as requested.

Performs other related duties as assigned. Qualifications Education and Experience Bachelor's Degree in Social Work, Clinical Counselling or other relevant health related discipline.

Current full resgistration with the BC College of Social Workers; or, current Canadian Certified Counsellor (CCC); or, BC Registered Clinical Counsellor (RCC) designation.

Two years' relevant clinical experience in either a psychiatric acute, community or outreach setting including one year of experience working with indigenous clients or an equivalent combination of education, training and experience.

Valid B.C. driver's license and access to personal vehicle for business related purposes. Skills and Abilities Demonstrated knowledge and understanding of Indigenous cultural practices and beliefs with reference to mental health and substance status.

Demonstrated counselling, client assessment and case management skills. Demonstrated ability to communicate effectively in English, both verbally and in writing, including empathic and respectful communication appropriate to the situation.

Demonstrated ability to establish rapport with clients, families, and members of the interdisciplinary team, and including the ability to effectively network with other services and agencies.

Demonstrated ability to prioritize and organize work. Demonstrated ability to work independently with minimal supervision.

Knowledge of the principles, practices, and theories of Social Work / Clinical Counselling as applied to Indigenous populations.

Knowledge of community resources and methods of accessing them, with particular application to Indigenous communities. Comprehensive knowledge of emergency triage procedures, mental health status assessment, and counselling principles and interview techniques.

Working knowledge of psychopharmacology, crisis theory, and de-escalation techniques. Working knowledge of DSM V Multiaxial or International Classification of Diseases 10 Diagnosis.

Physical ability to carry out the duties of the position.