Social Worker

Job title: Social Worker

Job description: Building healthy communities through outstanding care, innovative partnerships, and amazing people.

Join our team and together we will make progress on our Strategic Goals:

• Forge a new path to meet the changing needs of our growing communities
• Champion a culture of exemplary care and deliver clinical excellence
• Create an environment where the best experiences happen
• Own our role to improve the system

Through new partnerships, a relentless focus on quality and sustainability, and a dedication to the best patient and provider experience, Southlake will improve the health of our communities and shape the future of healthcare.

Job Summary

The Social Worker works as a member of the interdisciplinary team to provide social work support and discharge planning services and expertise. The Social Worker provides in-depth psychosocial assessments and appropriate interventions for patients and their caregivers, including resource education, emotional support, counselling, case management, and advocacy, to maximize patient quality of life within their community. They will coordinate comprehensive discharge plans with the interprofessional health care team for primarily complex patients and their families.

• Functions as a member of the interprofessional team to coordinate complex discharge plans; provide linkages to community resources and to support patients, families and caregivers to transition through the continuum of care.
• Functions as a member of an interprofessional team to coordinate complex discharge plans, communi
• Provides comprehensive and coordinated psychosocial assessments.
• Facilitates and participates in appropriate patient care planning in daily bullet rounds and case conferences.
• Assists the patient, family and caregiver to better understand the impact of their illness/disability.
• Provides short term crisis and grief counselling for patients, families and caregivers.
• Provides information and education to patients, families and caregivers pertaining to their plan of care including discharge.
• Maintains relevant documentation of social work services as per the Ontario College of Social Workers and Social Service Workers (OCSWSSW) standards available on the link included: https://www.ocswssw.org/professional-practice/code-of-ethics/
• Holds primary responsibility for complex discharge planning across programs.
• Utilizes all systems, policies and processes to facilitate sustainable and durable discharges (i.e., iplan, PODS, RM&R, care pathways, etc.)
• Actively works with the Charge Nurse.
• Identifies disposition challenges to the Unit Manager and works in a collaborative and interdisciplinary manner with all team members within the hospital and across the care continuum, including the CLHIN and other community supports.
• Populations who most frequently require complex discharge planning include but are not limited to:

▪ Patients who hold Alternative Level of Care (ALC) status
▪ Patients with Acquired Brain Injury (ABI) (new diagnosis within 6 months)
▪ Residents from group homes
▪ Populations experience housing challenges and homelessness
▪ Patients requiring advanced care planning, SDM/Power of Attorney (POA) – Discussion/education or those with complex SDM/POA family dynamics
▪ Hardship regarding finances
▪ Cases related to capacity issues in relationship to personal care, finance and/or property
▪ Palliative patients to be supported in death in the place of their choice
▪ Patients with palliative status either remaining in hospital or going home
▪ Families/caregivers requiring support in building & maintaining resiliency through linkage with community partners
▪ Concerns related to suspected or actual child abuse and/or seniors abuse
▪ Patients with Drug Coverage challenges requiring liaison with pharmacy services re: drug availability
▪ Patients who require assistance to acquire a valid OHIP card
▪ Patients involved in a Motor Vehicle Accident requiring liaising with third party insurers
▪ Patients who require support for liaising with the Workplace Safety and Insurance Board (WSIB)

• Links patients with appropriate community supports/services as required for ongoing follow up intervention on transition from hospital to community.

Qualifications

• Masters’ Degree in Social Work from an accredited university required.
• Member in good standing with the Ontario College of Social Workers and Social Service Workers (OCSWSSW), with no terms, conditions, or limitations required.
• Minimum three years relevant social work /discharge planning experience within an acute care setting preferred.
• Demonstrated ability to provide the provision of assessments and treatment planning, conflict resolution and problem solving for both inpatients and outpatients.
• Working knowledge of legislative acts to include, but not limited to: Mental Health Act, Long Term Care Homes Act, Retirement Homes Act, Child Youth and Family Services Act, Health Care Consent Act, Substitute Decisions
• Working knowledge and experience with transitions in care planning, relevant community resources and system navigation.
• Demonstrated knowledge and skills in psychosocial assessment, conflict resolution, and creative problem-solving.

• Demonstrates capacity to work co-operatively and constructively with other team members and develop effective partnerships with community agencies.
• Demonstrated strong communication and interpersonal skills, with the ability to work. collaboratively with patients/families, interprofessional team members, and other stakeholders
• Demonstrated excellent organizational and coordination skills and the ability to prioritize multiple competing workload demands.
• Demonstrated excellent written and verbal communications skills.
• Demonstrated flexibility and ability to work under pressure in a fast paced environment.
• Demonstrates flexibility to meet additional responsibilities as program demands.
• Demonstrated understanding and complies with patient and staff safety policies and procedures that foster a safe and inclusive environment for all.
• Demonstrated commitment to providing an exceptional experience for staff and caregivers within a challenging and exciting health care environment.
• Models behaviour that is aligned with the values of Southlake Regional Health Center

 Always with compassion
 Power of many
 Serve with purpose
 Every voice matters
 Courage to think differently

At Southlake, we are committed to fostering an inclusive and accessible environment. We are dedicated to building a workforce that reflects the diversity of the community in which we live and serve, including those with disabilities. Southlake is committed to providing accommodations in all parts of the hiring process. If you require an accommodation, we will work with you to meet your needs.

It is the responsibility of all Southlake employees to work in a safe manner and promote health and safety in the workplace.

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