The VA Palo Alto Health Care System (VAPAHCS) is recruiting for a Social Worker to service as the Domiciliary/HUD-VASH Case Manager. The incumbent provides social work services to the veteran population enrolled at the VAPAHCS, to include provision of high quality case management, advocacy and coordination of linkages to other appropriate VA or community service providers and/or agencies as needed by the client. Program Administration and Organization Assists with data collection, record keeping and monitoring patient or program clinical indicators, thresholds and performance measurements. Assists with the establishment, implementation and maintenance or referral and screening procedures for potential HUD-VASH veteran participants that meet national policy as well as the needs of medical center mental health services as residential programs. Outreach Conducts and participates in outreach activities including field interviews, assessments and referrals for homeless veterans contacted in the community, shelters, and "on the streets," as well as those who are referred by VA residential programs, medical center or outpatient clinics. Housing Assessment Evaluates the veteran's situation, abilities, capabilities ad arrives at a reasoned conclusion including an assessment off vulnerability and prioritization for admission to the HUD/VASH program. Assesses at-risk factors and develops a preliminary plan, involving the veteran and family or significant others, to assit Veterans in obtaining housing. Referral, Rehabilitation and Program Admission Provides referral to VA medical and mental health inpatient and outpatient treatment and to other VA services including VA benefits, as well as community-based social services and other non-VA entitlement programs. Provides referrals or consults, or in some cases direct admission of the veterans prior to HUD/VASH participation, for other VA programs including community-based residential treatment such as Grant and Per Diem (GPD) Programs, Health Care for Homeless Veterans (HCHV) contract residential treatment, Domiciliary or Psychiatric Residential Rehabilitation and Treatment Programs (PRRTP), or Compensated Work Therapy (CWT) and Compensated Work Therapy Transitional Residence (CWT/TR) Programs Comprehensive Case Management Develops psychosocial treatment plans, actively involving the veteran and their family or significant others, with interdisciplinary team members based on the psychosocial assessments, including goals for clinical treatment. Makes initial and continuing decisions coordinating the veteran's care through linking and referral to VA medical facilities or Regional Offices and other VA and non-VA services. Provides case management services while utilizing professional skill, objectivity, insight, training, and experience to interpret data and to identify viable treatment options and recognizing potential high-risk factors, acuity, and needs for services. Assists veterans in maintaining appointments at VA medical centers and other community agencies for medical, psychiatric, substance abuse, vocational and other services consistent with veteran's goals associated with healthful independent living. Refers veterans to appropriate VA and other government/community services-including local shelters, food banks, employment services, veteran's benefits, and social security applications. Assists veterans who encounter problems obtaining services from the VA and other service delivery agencies through advocacy, linking, and/or by assisting with their problem solving/social interaction skills. Participates in the assignment of veterans to treatment teams and programs and consults with other specialists in planning treatment for veterans with co-morbidities. Direct Services Under the direction of the clinical supervisor, the incumbent provides direct case management services for veterans and family members or significant others in support of the veteran's treatment. Gives advice, guidance, emotional support and crises management services needed to maintain the veteran safely in their residence. Assists and encourages veteran and significant others in facing problems, thinking them through, evaluating the situation, considering alternative courses of action and arriving at plans for using resources to resolve problems. Maintains treatment plans based on assessment for each veteran which are reviewed quarterly with updates as needed. The incumbent makes routine visits to each veteran in residence to assess his/her environment and provide on-going case management services. Demonstrates acceptance, interest, and encouragement and includes the veteran in their course of treatment and utilizes methods and techniques to maintain a therapeutic relationship that recognizes the value of the veterans input in their care. Receives and completes consults requesting services from interdisciplinary team members and from other mental health professionals on complex, difficult cases. Other duties as assigned.
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.