Responsible for direct social work intervention to patients to facilitate their understanding and resolution of problems related to environmental stress, physical illness and interpersonal conflicts that may impede treatment and recovery.  Coordinates with the  interdisciplinary care team to provide holistic family-centered care for patients and families across treatment settings. Coordinates and conducts support groups for patients and families.

 

Assesses and identifies the patient’s and family’s psychosocial needs by reviewing the medical record, interviewing the patient and/or family, and consulting with members of the patient’s care team. Develops the psychosocial aspects of the plan of care by specifying services to be rendered based on assessed needs; plans and implements the plan in compliance with third party regulators and ProMedica policies, procedures, and standards of practice. Facilitates the patient and/or family adaptation and adjustment to illness and its impact on the home situation by providing therapeutic interventions such as crisis counseling, anticipatory guidance, and conflict resolution.  Goal-oriented interventions are directed toward chronic disease management, reaction/adjustment to illness, strengthening family/support system, conflict resolution related to illness, and other services that act to alleviate imposed environmental stressors on the patient and/or family. Assists patient and family in establishing advanced directive/care decisions, maintaining the patient’s dignity and supporting the patient’s unique spiritual and cultural beliefs. Documents problems, psychosocial assessment, appropriate goals, care provided, interventions, and patient, family and caregiver response to each intervention. Provides appropriate information and educational materials for patients and family. Collaborates with and refers questions to other health team members. Identifies available community resources and makes appropriate referrals. Demonstrates organization and flexibility in patient care assignments to adequately perform the job functions and satisfy the needs of the patients.