The Care Coordinator supports individuals with disabilities and their families, with a particular focus on families in Category B by planning, organising, and coordinating services to enhance their quality of life and promote independence. The role includes assessing needs, developing and implementing care plans, facilitating access to appropriate services, and providing ongoing support. It involves working closely with clients, families, service providers, and community agencies to develop and monitor individualized care plans. The Care Coordinator acts as a central point of contact between the individual, their family, healthcare providers, support agencies, and community resources.
Key responsibilities
Communication and Relationship Building
- Build trusting and respectful relationships with the individual, family, and service providers.
Screening of Caregivers
- Conduct and/or oversee the implementation of screening (using the Caregiver Needs Screening Tool) and triaging of caregivers to tiered support within the services.
Education and Empowerment
- Create awareness and understanding in caregivers and care recipients of available resources and support services they can tap on (e.g., government programmes, financial assistance etc.).
- Empower the dyad to make informed decisions about their care and life.
- Help families navigate support services.
Care Planning
- Based on caregiver screening (and assessments, where relevant or needed), to develop a person- and family-centred care plan in collaboration with the family and relevant stakeholders. Ensure the plan aligns with individual and collective goals.
- Identify short-term and long-term goals of the caregiver and care recipient individually and collectively.
Coordination of Services
- Arrange and coordinate services
- Advocate for their needs, if necessary. Act as a single point of contact for the family.
- Assist with referrals and right-siting of services and programmes.
- Facilitate communication and collaboration between different service providers.
- Participate in case discussions and client/family conferences.
- Coordinate multidisciplinary team meetings to ensure integrated and consistent care, if needed.
- Stay current with best practices, local services and resources, and policies affecting disability services.
Monitoring and Evaluation
- Regularly review and update the care plan to reflect changes in the dyad or circumstances.
- Monitor outcome by tracking progress toward goals, ensure quality of services are person-centred and culturally appropriate. Address any issues or concerns.
Adjust plans as needed.
Seek and use input from the person and family to improve coordination and services.
Practical Support
- Offer practical assistance, such as help with forms, scheduling appointments, or navigating service systems (e.g. facilitate client placement in desired services/care facilities)
Crisis Management
- Assist dyad to plan for management of crises (e.g., sudden health issues, housing instability).
- Develop contingency plans and ensure quick access to emergency services if needed.
Transition Support
- Facilitate the handover of the dyads when escalated to or de-escalated from one tier to another.
- Help navigate life transitions, such as moving between/ into and out of adult services,
- transitioning from home to supported living, or entering the workforce.
- Follow-up with service drop-outs
- Collaborate with external providers and community partners to ensure continuity of care.
Requirements
- Possess Degree in Social Work or Degree with a Graduate Diploma in Social Work from an accredited institution
- Preferably with 2-3 years of social work experience
- Analytical, flexible, resilient and ability to see different perspectives and draw connectivity and suitably make recommendations.
- Committed, responsible, able to work independently and be a contributing team player.
- People-oriented and have good interpersonal skills.
- Effective report writing skills.