Clinical Social Worker, Primary Care - Delta

Fraser Health Authority; Delta; On-site; CAD 62,000 - 77,000; Full time

Job summary

Fraser Health Authority is seeking a Clinical Social Worker to join the Primary Care Centre Network in Delta, BC. You will work within an interdisciplinary team to provide social work services, promote self-determination, and support unattached residents with longitudinal primary care.

The role emphasizes trauma-informed, client- and family-centred care, with collaboration across UPCC, PCC, or PCN settings to improve care delivery and outcomes.

Qualifications

• Bachelor’s degree in social work.
• 2 years' related experience in a complex health care environment.
• Full registration with the BC College of Social Workers.
• Valid B.C. Driver’s license and access to vehicle with appropriate business coverage.

Responsibilities

• Conducts comprehensive social work and psychosocial assessments by interviewing the client and/or family and interpreting data using various tools.
• Provides short-term crisis intervention for mental health and substance use issues.
• Collaborates with the interdisciplinary team in care planning and follows up on complex psychosocial situations.
• Maintains patient records and documents assessments, progress notes and reports per standards.
• Coordinates referrals to community resources and supports continuity of care.
• Assists in discharge planning and coordination of services across the health care system.

Skills

Counselling skills

Psychosocial assessment

Crisis counselling

Interdisciplinary teamwork

Communication skills

Time management

Education

Bachelor's degree in Social Work

Tools

EMR systems

Job description

Salary

The salary range for this position is CAD $44.85 - $56.02 / hour

Job Summary

Are you someone who enjoys working an interdisciplinary team? Do you thrive in an environment where you are promoting self-determination? If you have answered yes to these questions, we want you to continue reading and explore the next stage of your career!

We currently have an exciting opportunity for a Full Time Clinical Social Worker to provide services at our Primary Care Centre Network located in Delta, B.C.

Requirements

• Bachelor’s degree in social work
• 2 years recent related experience in a complex health care environment such as a community or home health setting, or an equivalent combination of social work education, training and experience.
• Full registration with the BC College of Social Workers
• Valid B.C. Driver’s license and access to vehicle with appropriate business coverage

Detailed Overview

The Clinical Social Worker, Primary Care is a member of an interdisciplinary team within either Urgent and Primary Care Centres (UPCC), Primary Care Clinics (PCC), or Primary Care Networks (PCN).

The Clinical Social Worker conducts comprehensive social work and psychosocial assessments of clients and their families using a variety of assessment tools to provide treatment services for clients, including liaising with community agencies and caregiver support groups; provides clinical support to the interdisciplinary team, including physicians and nurse practitioners in the development of care plans and services within the assigned area of responsibility; delivers and evaluates clinical services and outcomes; participates on local committees and planning bodies to identify areas to improve the efficiency and effectiveness in service delivery to enhance client care services and reduce service gaps.

The Clinical Social Worker within the UPCC or PCC provides timely care to residents and continuous longitudinal primary care to unattached vulnerable residents in the assigned region.

The Clinical Social Worker within the PCN provides continuous longitudinal primary care to patients attached to local primary care providers. This role may require outreach and share care visits at primary care providers’ offices.

This role provides culturally safe client and family-centred care through a trauma-informed approach and evidence-informed practice in accordance with professional standards, clinical policies, legislation and practices. Establishes a dignifying, purposeful and trusting relationship with clients, promoting self-determination and independence. Encourages knowledge exchange in day-to-day activities, and empowers clients and natural supports to engage and connect within their communities; ensures clients and their family members are supported in navigating the health care system.

Responsibilities

1. Conducts comprehensive social work and psychosocial assessments by interviewing the client and/or their family, obtaining relevant information, gathering social data and interpreting the data using a variety of tools.
2. Provides comprehensive therapeutic services by exploring the psychosocial response to identify problems, personal concerns, treatment objectives and facilitates change in coping style, behaviour, attitude and feelings; participates with the client, families, community supports and the interdisciplinary team to coordinate services, manage cases and facilitates meetings.
3. Provides short-term brief/crisis intervention for patients with mental health and substance use issues using a variety of interviewing, clinical counselling and assessment methods.
4. Collaborates with the interdisciplinary team in client care planning by interviewing the client and/or family to assess and determine care plan and type of service required; follows up and provides ongoing monitoring of complex psychosocial situations; evaluates client’s response to interventions.
5. Supports a seamless approach to care and service delivery across the healthcare system by participating in the admission and discharge process of clients in acute care and community; arranges meetings to assist in developing and coordinating comprehensive care plans and community services for clients; collaborates with the hospital and community services to determine the effective utilisation of available resources.
6. Partners with community services, health and social agencies including provincial Ministries, physicians and other primary care providers in the assessment and management of individuals at risk, making referrals to appropriate resources when longer term treatment or follow-up is required and exchanging relevant information.
7. Facilitates timely exchange and provision of information regarding client care between the acute care facility and the community service to allow for individualised discharge planning; works with community service providers to ensure client care needs are met.
8. Acts as a clinical resource for clients and their families by providing information regarding community resources and access to these resources, facilitating referrals where appropriate; determines if client is capable of making decisions around client care plans, in collaboration with the interdisciplinary team; refers client to appropriate health care professional for assistance and follows procedures around client incapacity, respecting the client’s right to privacy and confidentiality. 9
9. Maintains patient records by documenting assessments, charting information and preparing progress notes and reports in accordance with established standards, policies, procedures and current regulatory requirements.
10. Maintains a variety of records such as workload statistics by recording information into approved formats, collating data, analysing trends, accounting for variances, preparing reports as required and provides recommendations to the Manager, Clinical Operations, as required.
11. Develops, coordinates and delivers in-services, presentations, psycho-educational and support groups and/or training by collaborating with members of the interdisciplinary team, determining relevant content, conducting literature searches, planning and coordinating seminars.
12. Participates on local committees and planning bodies to identifying opportunities for change, assess available resources, analyse outcomes and identify areas to enhance patient care services and reduce service gaps.
13. Initiates, develops and carries out research activities and programme planning and development relevant to the needs of the patient, families, hospital and community, as assigned.
14. Arranges and participates in joint home visits to clients and/or families with other healthcare professionals, as required; provides advice to the clients and/or caregiver about available community resources.
15. Performs other related duties, as assigned.

Qualifications

Education and Experience

Current full registration with the BC College of Social Workers.

Two (2) years' recent related experience in a complex health care environment such as a community or home health setting, or an equivalent combination of social work education, training and experience.

As required, valid B.C. Driver’s license and access to vehicle with appropriate business coverage.

Skills & Abilities

• Comprehensive knowledge and understanding of counselling and clinical practice models as it related to individuals, families and groups
• Demonstrated ability to conduct comprehensive social work and psychosocial assessment
• Comprehensive counselling skills including crisis counselling, brief therapeutic interventions and loss and grief applicable to patient, families and their support networks
• Comprehensive knowledge of pertinent/relevant health care and privacy legislations
• Ability to educate and provide consultation to patients, families and healthcare professionals
• Ability to effectively work independently and with others including working effectively in a multicultural environment, as part of an interdisciplinary team
• Demonstrated ability to communicate effectively both verbally and in writing
• Demonstrated ability to organise and prioritise workload in a complex environment
• Knowledge of community resources and methods of accessing them
• Ability to operate related equipment including applicable software applications
• Physical ability to carry out the duties of the position

About Fraser Health

Fraser Health is the heart of health care for over two million people in Metro Vancouver and the Fraser Valley in British Columbia, Canada, on the traditional, ancestral and unceded lands of the Coast Salish and Nlaka’pamux Nations and is home to 32 First Nations within the Fraser Salish region.

People - those we care for and those who care for them - are at the heart of everything we do. Our hospital and community-based services are delivered by a team of 50,000+ staff, medical staff and volunteers.

We are committed to planetary health and value diversity in the work force. We strive to maintain an environment of respect, caring and trust. Fraser Health’s hiring practices aspire to ensure all individuals are treated in an inclusive, equitable and culturally safe manner.

Together, we are the heart of health care.