Role Description
Licensed Mental Health Professional to work on a new funded innovative care transition team that serves participants transitioning to the community from a higher level of care. The role will involve facilitating transition from one level of care to the community by addressing the preparatory needs of participants in the early stages of recovery, discharge planning, development of daily living skills, and coping mechanisms through team and individual work in the community. The team will follow participants into the community using the Pathway Home model of care to ensure that they become both linked and engaged with identified community providers and that their support network is enough to meet their needs. The role will require some on call coverage.
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Engagement beginning from referring location with involvement in transition planning, including a needs assessment of community transition supports essential to stabilizing the individual.
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Monitor appropriate discharge and ongoing care planning at pre- and post-transition for individuals transitioning to community.
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Establish collaborative working relationships and act as a liaison with community providers, Managed Care Plans, and Housing Contractors.
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Short term counseling (coping skills, trauma informed, decision making) and Risk Assessment/Safety Planning.
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Provide supervision to team members and orient new team members to policy and procedures as well as ongoing training and mentorship.
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Collects and reports data, as required while adhering to productivity standards.
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Participate in both the development and implementation of a community care plan that includes formal and informal support that increase opportunities for improved quality of life. Focus is on creating meaningful and productive daily activities in the community.
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Assessing Housing Supports and Housing Assistance and Placement for those who are homeless.
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Work with participants and their housing providers to resolve clinical issues that are impacting on the participant’s ability to obtain, manage, and retain supportive housing.
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Foster relationship with community providers to ensure that recipients are connected with appropriate services as they transition back into the community.
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Appointment navigation by accompanying to first behavioral health and medical appointment.
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Review documentation and conduct comprehensive psychosocial assessments to determine the medical, psychiatric, housing and other social needs in the community.
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Obtain historical and collateral information from multiple sources as it relates to behavioral and physical health, substance use, and criminal history.
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Monitor, evaluate and record participant progress with respect to care plan goals.
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Counsel participants in individual and group sessions to assist them in dealing with substance abuse, mental and physical illness, family issues, housing problems and unemployment and other social determinants of health.
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Provide ongoing family conferences and psychoeducation to families and others within the support network.
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Provide on-call after hour crisis intervention services when needed to participants and their support network.
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Attend and participate in team meetings and supervisory sessions.
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Perform other related duties as assigned.
Qualifications
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Master’s degree or higher in social work, Mental health counseling, nursing or psychology.
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A minimum of 3 years post-masters’ work.
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Experience in the behavioral health and/or criminal justice field, preferably with the target population.
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Effective written and oral communication skills.
Requirements
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Knowledge of mental illness and serious emotional disturbances and substance use disorders.
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Knowledge of treatment, rehabilitation, and community support programs as they relate to recipient/residents, families, and staff.
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Knowledge of techniques for identifying and preventing potentially violent behavior, including crisis management techniques.
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Experience with group work.
Benefits
We’re proud to offer a comprehensive benefits package designed to support your wellbeing and development. From health and wellness resources to generous PTO, professional development, and more, explore all that we offer on our Benefits Page and see how S:US invests in you.
Company Description
S:US is an equal opportunity employer. We believe in fostering a culture built on our core values: respect, integrity, support, maximizing individual potential and continuous quality improvement.
S:US is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.