Outreach Worker, Sexual Health and Blood Borne Infection Case Management

Detailed Overview

The Outreach Worker, Sexual Health and Blood Borne Infection Case Management acts as a member of an interdisciplinary case management team, specifically to provide ongoing, outreach services to individuals at risk or living with HIV who are difficult to engage or retain in care. From a strengths-based model, using motivational interviewing and engagement techniques, the Outreach Worker works collaboratively with clients and the interdisciplinary case management team to develop and implement individualized care plans and assists clients to access appropriate services in the community. The Outreach Worker assesses the clients, determines referral needs, liaises with community resources for further and/or specialized services, formulates and implements case management plans in conjunction with the clinical case management staff. Responsibilities Participates in the development and implementation of a care plan for assigned clients; identifies actual or potential problems and strengths, works with team to plan interventions, performs planned interventions and evaluates outcomes. Monitors clients by methods such as observing client's health condition and functional environment including functional ability, living arrangements, and family supports, documenting behavioural, physical and cognitive changes in accordance with standard procedures or specific directions, and reporting significant and unsafe observations to the Registered Nurse or delegate. Monitors clients' progress, communicates and consults regarding the care and support plan with the client and the case management team in order to ensure continuity of appropriate care for the client. Creates linkages to other community resources and programs, contacts relevant organizations/businesses/services, assists clients with processing forms. Assists clients with access to other resources (food, supplements) and provides advocacy and crisis intervention. Communicates and consults with the Nursing Supervisor and other team members of the case management team about client care issues and participates in interdisciplinary conferences and with other health professionals, as required; explains plan of care to clients; refers clients to community resources as appropriate. Assists clients in accessing benefits or assistance as appropriate and provides brief assessment and planning on issues related to HIV, social determinants of health such as income security, housing, social networks, self-efficacy and self care. Acts in an advocacy role with government agencies, health care providers and landlords. Works with the team in linking the client to support services to ensure optimal support, autonomy and quality of life for the client; explains the plan of care and provides support and education to the client as appropriate; facilitates the involvement of clients in self-help approaches. Arranges, plans, escorts and accompanies, as necessary, individuals on medical appointments and errands, while providing emotional, moral support and physical assistance to further development of self management skills. Participates in quality improvement activities and research by identifying client care issues, and collecting and analyzing data, and providing input to the Nursing Supervisor and Manager. Maintains an accurate record of outreach activities; writes timely and accurate reports of relevant observations to ensure continuity of communication and full client documentation. Maintains client records, related reports and statistical data in accordance with established standards, policies and procedures Performs other related duties as assigned. Qualifications Education and Experience Diploma in Community Social Services and two years' recent, related experience working with individuals living with HIV/AIDS, Hep C, mental health issues or equivalent combination of education, training & experience. Valid BC Driver's License and access to a personal vehicle for business-related purposes. Skills and Abilities Working knowledge and familiarity with health and social services programs in Fraser Health and in the lower mainland. Working knowledge of harm reduction principles. Advocacy skills. Ability to work independently and in cooperation with others including working effectively in a multicultural environment as part of an interdisciplinary team. Ability to work with marginalized and culturally diverse populations. Ability to communicate effectively, both verbally and in writing with clients, families, and staff and community agency personnel. . Ability to organize and prioritize. Ability to establish and maintain rapport with clients. Ability to observe and recognize changes in clients. Ability to analyze and resolve problems. Conflict resolution and crisis intervention skills. Ability to make effective referrals, reflecting in-depth knowledge of community resources. Ability to operate related equipment including the use of personal computers, related word-processing and database management software applications. Physical ability to carry out the duties of the position. About Fraser Health Fraser Health is the heart of health care for over two million people in Metro Vancouver and the Fraser Valley in British Columbia, Canada, on the traditional, ancestral and unceded lands of the Coast Salish and Nlaka’pamux Nations and is home to 32 First Nations within the Fraser Salish region. People - those we care for and those who care for them - are at the heart of everything we do. Our hospital and community-based services are delivered by a team of 48,+ staff, medical staff and volunteers. We are committed to planetary health and value diversity in the work force. We strive to maintain an environment of respect, caring and trust. Fraser Health’s hiring practices aspire to ensure all individuals are treated in an inclusive, equitable and culturally safe manner. Together, we are the heart of health care. Instagram | Facebook | LinkedIn | X | Indeed | Glassdoor IMPORTANT: Recruitment scam warning Please be on alert for recruitment scams. We are aware of several scams targeting individuals by falsely claiming to represent Fraser Health. Always take precautions when sharing personal details with unverified sources. Please note that we will never ask for money or payment, nor ask you to download or install an app at any point during our recruitment process.