Experience
Independently performed case finding functions and outreach, identifying and screening patients for psychosocial needs.
Conducted psychosocial assessments and facilitated community and benefits related referrals based upon veterans needs and eligibility.
Developed treatment plans in collaboration with the veteran/family and with the interdisciplinary treatment team.
Coordinateed community-based services, including information and referral for additional services from other VA programs.
Provided consultation and guidance to colleagues on clinical matters, and develops innovative practice interventions.
Delegated outpatient work assignments to ensure adequate clinical coverage of outpatient PACTS, involving the Primary Care Social Work Supervisor, Patient Advocates and other leadership staff as needed to resolve issues or concerns.
Provided crisis intervention services, to address the cause as well as the presenting complaint and coordinated family conferences.
Established and maintained effective therapeutic relationships with veterans and their families and communicated effectively.
Educated the staff regarding the psychosocial needs of veterans and the impact of psychosocial problems on health care.
Provided clinical social work services to identified patients and families including psychosocial assessment, care coordination and individual and group counselling regarding the impact of illness and hospitalization.
Coordinated between family, hospital and community resources to assure continuity of care in the hospital and post-hospitalization.
Participated in educational programs for students as well as physicians, nurses and other health care professionals as required.
Provided orientation for new social workers, interns, and medical staff in outpatient clinical settings regarding how to best partner with Primary Care Social Work, adult and child protection reporting responsibilities, etc.
Improved professional skills by participating in planning and executing specific staff development projects, attending seminars and institutes and participates in training programs or other disciplines as requested.
Defined the role of social work within the PACT model of care, participated in the development of SOP and standardization of processes.
Actively participated in program planning and development, advising the supervisor of shifting trends with caseloads and veterans.
Identified the need for and made recommendations on program procedure or policy changes based upon work experiences.
Worked with other multi-disciplinary teams and community agencies to strive for developing more effective and efficient ways of delivering healthcare to veterans.
Assessed patients' psychosocial status, strengths and areas of need that may affect rehabilitation and optimal treatment outcomes as part of the comprehensive patient assessment.
Participates in care planning in collaboration with the patient and healthcare team to identify effective interventions that will help the patient meet rehabilitation, treatment goals, and improve quality of life.
Provided monitoring and interventions for the patient to adjust to dialysis and achieve optimal psychosocial status.
Provided supportive counselling services to patients as permitted within the scope of their clinical training and state license.
Provided educational and goal-directed counselling to patients who are seeking transplant.
Education
Certifications
Skills
Industry Knowledge: Consultation, Social work, Clinical Social Work, Psychology, Communication, Empathy
Summary
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