The role starts from inpatient engagement with high risk patients prior to discharge to assist in outpatient transitions of care process including scheduling to come to the TCC or other community providers
Responsibilities will include completion of psychosocial assessments, involvement of patients in the development of individualized discharge plans, collaboration with the multidisciplinary team, and referrals to identified treatment and support services in the behavioral health system.
Provides clinical social work services or psychosocial assessments to patients/residents and families, regarding the following common problems: adjustment to instituitional living, financial concerns, family relationships, difficulty understanding / accepting medical / diagnoses / procedures / treatments, changes relating to aging, powerlessness, discharge planning and counseling related to death and dying.
Performs psychiatric assessment, formulates diagnosis and in consultation with referring physician recommends and completes appropriate disposition. Discusses case with Attending Physician to determine if the patient has been cleared medically and to determine why a consult is requested. Responds in timely manner to request from Emergency Department Physician for psychiatric consultation.