Graduate Social Worker

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Participates as part of an Interdisciplinary Team in the formulation and ongoing evaluation of an individualized, age-specific, culturally responsive Plan of Care for each patient and family.

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Conducts comprehensive biopsychosocial assessments and ongoing reassessments of patients and families including identifying spiritual needs and patients and families at social or psychological risk.

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Identifies community resources, coordinates resource management, and evaluates outcomes of resource planning with patients and families and educates patients and families on factors impacting care, treatment options, disease process and issues of grief and loss.

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Provides crisis counseling to patients and families who demonstrate symptoms of maladaptive defense mechanisms, ineffective coping skills, pathological grief reaction or mental illness.

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Arranges the process and facilitates patient and family in the understanding of patient transfer when level of care changes from inpatient, home, or LTC.

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Demonstrates ability to evaluate diverse patients’ and families’ adaptation to hospice care and works effectively with them on issues of death, dying, treatment modalities, and spiritual beliefs.

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Accurately documents and verbally communicates assessment information, treatment plans and client system interactions as required by the organizational setting.

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Assesses the patient’s and family’s environmental, social and financial resources as they relate to the provision of patient care and develops a comprehensive, individualized plan of care with the patient and caregivers based on the biopsychosocial assessment.