POSITION SUMMARY :
The Social Worker St. Mary’s Health @Home (SW-SM H@H) program will provide psychosocial assessment, counselling / psychotherapy, case management, Patient / family education, supportive care, discharge planning, service coordination and consultation according to best practice standards in order to assist the client in achieving optimum recovery and quality of life.
This role supports Manager – Therapy Services in the efficient and effective operations of the program activities, as well as provide leadership in high risk social situations, program development, advocacy and developing and maintaining strong community linkages. Registered Social Workers will also participate in mentoring community development, teaching, continuous quality improvement and research activities.
Clients are typically individuals who have been discharged from hospital to their own home, but who still require some clinical care for a short period of time. These clients are in process of having long term care needs assessed, are medically stable, can be of any adult age group, and may require mechanical or 2-person lifts. Clients typically stay 21 days or 16 weeks in length, and they may or may not require a formal care plan.
CORE DUTIES AND RESPONSIBILITIES
Clinical
- Maintains current working knowledge of relevant legislation in Mental Health Act, Health Care Consent Act, Substitute Decisions Act, Public Hospitals Act, Long Term Care Act, Child and Family Services Act, PHIPA and Excellent Care for All Act
- Maintains expertise in generic social work practice and implements evidence-based practice which includes family / individual and group treatment modalities, case management, crisis intervention and discharge planning
- Documents all patient related interventions adhering to the OCSWSSW Standards of Practice and the RSW disciple-specific documentation guidelines
- Conducts comprehensive psychosocial assessments from a systems perspective which will include contact information (POA, SDM, NOK), current family / social status, financial situation, community agency involvement, mental health status, psychosocial history, social work analysis, identified issues goals and intervention plans
- Identifies and intervenes with high risk social work analysis, identified issues, goal and intervention plans
- Identifies and intervenes with high risk social situations such as intimate Partner Violence, Child Abuse / Neglect, Elder Abuse / Neglect, Financial Abuse, and others as appropriate utilizing best practice social work guidelines
- Provides theory-based counselling which may include crisis intervention and illness adjustment counselling
- Provides case management for an assigned client area including the facilitation of client and team goals related to function and discharge, connecting the client and / or family with services and / or resources in the community and ensuring patients and families understand the plan of care post discharge
- Coordinated all complex discharges and facilitates program specific case management activities
- Assumes the lead responsibility for discharge planning including the identification of client and family needs and resources related to safe patient discharges
- Provides mentorship around specific developed areas of expertise to new RSW staff and healthcare providers of other disciplines
- Meets the requirements of Ontario Social Work re-certification through continuing education as outlined by the OCSWSSW
- Complies with all required Workload Measurements and other statistical data collection expectations
- Engages in knowledgeable, sensitive and expert care of seniors, and support of their families
- Advocates in the best interests of the clients
- Completed regular, mandatory and optional professional development
- Engages in self reflection and adaptation to the changing needs of clients
Administration
Working with others in ordering of required supplies and / or equipmentRecording treatment activities in client charts, maintaining on-going support of other interdisciplinary program staffDeveloping and presenting reports and / or metrics as requestedSupporting clients in setting up therapy appointmentsSupporting referral / intake processes of the programProviding general assistants to program ManagersPerforming general administrative duties related to the roleParticipate on committees and program development related to areas of practice.CORE COMPENTENCIES
Regularly demonstrates our mission, vision and values : Support compassionate care, faith and diversityDeliver quality care, pursue and share knowledge, respect diversity, remain faithfulCommit to working everyday with dignity, respect, service, justice, responsibility and enquiryAbility to work collaboratively with others; sharing expertise and drawing on the expertise of othersActively promotes a healthy, supportive and inclusive work environmentProactively contributes to initiatives, supporting and encouraging positive changeAbility to engage in effective problem solving, possess logic and analytical thinkingSkilled at thinking about creative solutions to complex problemsSolid team-based approach to every day work activitiesSuperior communication skills both verbal and written, with an excellent customer service mind setPositive and professional, with a “can do” attitudeWillingness to regularly go the extra mile and actively support co-workersWillingness to learn and mentor with senior staff membersMaintaining on-going compliance to corporate policies and procedures, health and safety regulations, and relevant external standardsParticipating fully in both internal and external training requirementsParticipating fully in corporate quality initiativesMaintaining the privacy and confidentiality of all personal health records (including both client and personal), and following all the privacy and confidentiality requirements of any and all electronic medical record systems usedKEY EDUCAITON AND EXPERIENCE
Bachelor’s Degree in Social Work from an accredited University, requiredRegistered with the Ontario College of Social Workers and Social Service Workers, requiredMembership with the Ontario association of Social Workers, preferredMinimum one year recent and related experience, requiredGentle Persuasive Approach training, preferredPrevious experience using mobile tools and devices, preferredPrevious experience or education in Equity, Diversity and Inclusion and / or Indigenous Cultural Awareness, an assetPrevious experience in a Home or Community care setting, preferredWe are an equal opportunity employer, committed to equity, inclusiveness, and diversity across all our programs, practices, facilities, and team. AI is not used in our recruitment processes for the selection of candidates.
If you require any accommodations during the recruitment process, such as alternate formats of materials or accessible meeting rooms, please inform the hiring manager before your interview. Should you wish to conduct your interview in French, kindly contact our head office to arrange this in advance.