Social Work PRN

In unpredictable and/or unknown environments, assesses patient/family needs regarding psychosocial history including assessing emotional factors related to terminal illness, psychosocial needs, including risk factors such as mental health, suicidal and homicidal ideation, substance abuse, bereavement risk, and offers recommendations accordingly. Will also assess environmental resources and obstacles to maintaining safety.

Visits patients in various settings, to include but not be limited to: hospice inpatient units, private homes, long term care or assisted living facilities, group homes, shelters, or other locations where services to patients/families may need to occur. Manages a caseload of patients including, but not limited to, assessing for and assisting with advanced directives, funeral and memorial planning, assessment of care situation, and the provision of more complicated case management. Assesses for financial needs or barriers, and facilitates referrals as needed to internal and external resources. Provides patient/family education as appropriate and within the scope of practice.

Identify and utilize appropriate community resources and assess patient/family/caregiver ability to access them. Evaluate patient/family/caregiver response to intervention(s) when referred to community agency and the satisfaction of the services(s) provided. Provide clinical therapeutic services to patients and families such as, but not limited to: short-term individual counseling (loss, anticipatory grief and bereavement, coping, transition) to patient and/or family. Goals of Care discussions. Crisis intervention. Assistance in addressing/supporting decision-making, ensuring the best interest and rights of the patient.

Coordination and collaboration with ancillary therapeutic services, including but not limited to Child Life services and Music Therapy. Evaluate, intervene, and support the patient/family/caregivers throughout life transitions, regardless of disease trajectory and location on the continuum of the condition. Participate in IDG meetings as a contributing member of the team in ongoing communication, coordination, and continuity of the patient and family care/service needs from the psychosocial perspective, including the development and revision of the patients POC.

Act as advocate for patient/families right to self-determination. Assist the physician and other team members in recognizing and understanding the social/mental stress and/or disorder that exacerbates the symptoms related to terminal illness. Identify family dynamics and communication patterns; assess for special needs related to cultural diversity including communication, space, role of family members and special traditions. Identify the developmental level of patient/family and obstacles to learning or ability to participate in care of patient; assesses caregiver’s ability to function.

Identify support systems available to reduce stress and facilitate coping with acute and end-of-life care. Identify obstacles to compliance and assist in patient/family/caregiver understanding of goals and interventions; address patient/family/caregiver questions and issues. Educate and evaluate patient/family understanding and acceptance to change in program/level of care; communicate psychosocial information to include goals of care to new care providers, to include hospital or Community Hospice inpatient facility when transfer to a different care setting.

Provide services to patient/family/caregivers within the National Association of Social Workers (NASW) Standards of practice in Palliative and End of Life Care. May attend patient funeral/memorial services as able and appropriate. Ensure timely completion of all discipline-specific and organizational documentation according to Community Hospice policies and procedures. Participate in sharing information with other professionals through participation in organizations such as NASW.

Builds, develops and maintains relationships with area social workers, discharge planners and community agency staff in order to network and facilitate referrals of patients. Consult the Community Hospice Ethics Committee, when needed. Participate in program, organizational, community in-service programs or presentations, as appropriate. Participates in the organization on call schedule as needed. Other duties as assigned.

Education/Experience: Master’s Degree in Social Work from an accredited school of Social Work and three (3) years direct service experience. Experience in supportive counseling in group and individual settings, and/or direct service with clients and their families in health care setting. Experience in provision of case management services. Principles, practices and methods of psychosocial services interventions. Principles, practices and methods case management. Principles, practices and methods individual assessment. Principles, practices and methods counseling techniques including but not limited to grief, loss and bereavement. Principles, practices and methods reporting and referral. Verbal and written communication, assessment, supportive counseling, working within framework of interdisciplinary team, computer skills.

Required Licenses/Certifications: Current State of Florida driver’s license with driving record acceptable to Community Hospice of Northeast Florida insurance carrier, and reliable transportation.