Program Overview – Slaight Foundation, Community Care
This program is part of an initiative between WoodGreen and Michael Garron Hospital for the provision of integrated care. The initiative will offer a coordinated approach to maintaining housing, Assisted Living services, access to/coordination of capacity assessments and access to behavioural assessments/plans, access to geriatric consultations/assessments, psycho-social assessments, practical time limited/goal orientated case management, counselling, and psychoeducation to older adults and seniors living with geriatric, mental health, addictions, and cognitive issues such as dementia.
What You Will Do
- Perform psycho-social assessments.
- Develop and implement service plan and/or coordinated care plans with clients, care teams, and various service providers.
- Lead service co-ordination and provide system navigation and short-term and longer-term planning and follow-up support.
- Lead and/or participate in case conferences and clinical meetings in order to ensure the coordination of services and a continuum of care.
- Provide goal oriented services to clients over a specified period of time, through development and implementation of a service/care plan to address priority and emerging needs.
- Provide clinical and/or supportive counselling to clients utilizing a wide range of therapeutic approaches that best meet the clients’ needs and circumstances.
- Support access to capacity assessments and behavioural assessments as required.
- Support access to consultations/assessments with geriatricians, geriatric psychiatrists, and behavioural consultants as required.
- Collaborate with primary care, hospital staff, and Home & Community Care Support Services staff to support clients and facilitate smooth transitions between hospital and community.
- Provide preliminary assessment of risk in crisis situations, consult and devise an intervention and action plan, and provide crisis intervention.
- Provide crisis intervention and practical assistance to clients and/or family or caregivers as required in homes and community settings.
- Provide advocacy support for clients and/or their family or caregivers as required.
- Link clients and/or their family/caregivers to various community resources, and facilitate appropriate referrals to other community support services as required.
- Provide service that is responsive and culturally and linguistically sensitive to individual needs.
- Engage in ongoing outreach to ensure access to the program.
- Collaborate with community agencies to organize joint health promotion clinics/workshops.
- Provide mentorship, training, and/or supervision to student placements and volunteers.
- Maintain a client caseload and be able to plan for and execute discharges in a timely manner.
- Maintain appropriate records and documentation in a timely manner.
- Ensure the anti-racism objectives and community development principles of the organization are achieved within the program.
What You Bring to the Team
- Masters of Social Work (MSW).
- Registered Social Worker (RSW) in good standing with the Ontario College of Social Workers and Social Service Workers.
- Minimum of three (3) years of related experience in mental health, addictions, geriatrics and/or social work.
- Demonstrated experience working with older adults and seniors with mental health (including dementia) and/or substance use issues, chronic health issues, cognitive impairment, and responsive behaviours.
- Effective September 7, 2021, all newly hired employees will be required to provide proof that they have completed an approved course of vaccination against COVID-19 at least 14 days prior to commencing employment or provide documentation to support an exemption based on grounds covered by the Ontario Human Rights Act (i.e. Medical exemption).
What Will Set You Apart
- Demonstrated ability in supporting older adult and senior population including individuals who have significant mental health and/or addiction issues, history of trauma, violence/abuse, dementia, cognitive impairments, responsive behaviours, chronic physical health issues, etc.
- Demonstrated experience providing case management, undertaking system navigation, service planning/coordination, and leading/developing coordinated care plans.
- Demonstrated experience with therapeutic and supportive counselling.
- Knowledge of and experience with a brief therapy modality, such as Narrative, Solution-Focused, Cognitive-Behavioural Therapy, Motivational Interviewing and Trauma-Informed approaches, Gentle Persuasive Approach, PIECES, Problem Solving Technique (PST), etc. is an asset.
- Demonstrated ability in working effectively in a multi-disciplinary team or as a team member of a care team in collaboration with other community professionals.
- Proven working knowledge of theories of addiction, evidence-based treatment models, and best practice approaches.
- Thorough knowledge of issues affecting older adults and geriatric populations.
- Comprehensive understanding and knowledge of the mental health, addictions, health sector, and community resources.
- Strong assessment, clinical, and intervention skills.
- Effective oral and written communication skills and documentation skills.
- Effective interpersonal, time management, and organizational skills.
- Proven ability to apply and practice anti-oppression, anti-racism, trauma-informed, and harm reduction principles and strategies.
- Ability to be self-directed, independent, flexible, and exercise good judgment.
- Ability to work from a client-centred approach.
- Proven ability to minimize barriers through service delivery for low income individuals with mental health and substance use issues.
- Demonstrate knowledge of issues affecting marginalized communities, policies, legislation, programs, and other issues related to scope of practice and social determinant of health.
- Applied computer skills (MS word, excel, Internet) and ability to use client information systems.
- Experience with interRai CHA or CMH is an asset.
- Ability to communicate in a second language (Greek, Spanish, Bengali, Urdu, Tamil, Persian, Tagalog, Arabic, Mandarin, or Cantonese) is a strong asset.
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