The Social Worker provides clinical psychosocial and case management services at an independent practice level to eligible veterans and their family members to meet biological, psychological, social, and environmental needs. Veteran patients are primarily from the Chillicothe and Community Based Outpatient Clinic (CBOC) catchment areas. Veteran health care and psychosocial problems and needs are complex and require a high degree of clinical oversight and creative problem solving. The incumbent is required to interact not only with the patient but also family, significant others, community agencies, and other staff. Services are provided at the assigned site (Chillicothe VA or CBOC) or rarely in the community. Weekend and evening work may apply. Main reporting work station will be assigned at Chillicothe or a CBOC. Duties include but are not limited to: Collaborates with PACT team and conducts case-finding activities (reviews data sources) and develops/maintains a caseload of moderate to high severity or complexity. The use of national templated notes are mandatory for Social Work PACT Case Management including the Social Work Triage, the Social Work Comprehensive Assessment and the Social Work Case Management note. Psychosocial Assessment and Social Work Notes are used for Mental Health Cases. A generic Social Work Note can be used for all other contact. Documents independently in the medical records utilizing electronic formats. Assessment: Interviews veterans, their family members and significant others to establish facts about the veteran's situation, presenting problems and their causes, and the impact of such problems on the veteran's functioning and health as part of a social work comprehensive assessment for PACT or psychosocial assessment for mental health. Interprets and explains VA's treatment and benefit programs. Has the ability to serve veterans presenting with a range of needs and severity, some who may have frequent and severe crises, lack family or an adequate community support network, be poor at self-monitoring, frequently fail to comply with instructions and treatment, or have significant deficits in coping skills and require continuing professional psychosocial support. Treatment Planning: For PACT case-management, based on the social work comprehensive assessment, the clinical social worker uses professional judgment and advanced practice skills to make a psychosocial diagnosis. Assesses at-risk factors and develops a preliminary disposition plan involving the Veteran and family or significant others. Makes independent professional decisions and recommendations in support of collaborative agency action. Consults with other specialists in planning treatment for veterans and with co-morbidities. Is able to make realistic and difficult conclusions, the consequences of which may be unpredictable and serious to the Veteran. Implements Treatment: Provides clinical services to veterans and family members/significant others in support of the Veteran's treatment. Gives advice, guidance, emotional support, and other assistance. Provides individual or family counseling services, focused on support, growth and problem solving. Assists and encourages veterans and significant others in facing problems, thinking them through, evaluating situations realistically, considering alternative courses of action, and arriving at plans for using agency or a more natural resource to resolve problems. Evaluation, Education: Establishes a continuing relationship with the veteran, evaluating progress towards goals and adjusting the treatment plan as appropriate. Meets with veteran to assess accomplishments and re-establish goals. Monitors veteran's progress, maintains comprehensive documentation, ensures expert diagnosis and treatment of clinical disorders, and shows competent discretion in decision to adjust treatment. Makes recommendations for care and changes to interdisciplinary treatment plan. Outreach, Coaching, and Mentoring: Provides orientation and on-going training to Social Workers and interdisciplinary team members. Conducts staff development programs for Social Workers and takes responsibility for providing opportunities to help staff update their Social Work practice skills and acquire new knowledge in contemporary treatment methods. Work schedule: 7:30 AM to 4:00 PM (Monday through Friday). Compressed/Flexible Schedule: Not Available. Financial Disclosure Report: Not Required. Virtual: This is not a virtual position. Functional Statement Title: Social Worker (Mental Health/Primary Care PACT) Relocation/Recruitment Incentives: Not Authorized.
Providing Health Care for Veterans: The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year.