• Employment Type: Full Time
• Shift: Days
• Hours: 8-4:30 M-F with 1-2 days remote work
• Location: Boston, MA

LCSW Transplant Social Worker Abdominal Transplant assesses psychosocial needs and applies comprehensive interventions to support the medical treatment plan. The social worker will utilize interventions to enhance patient and family functioning and emotional well-being and access appropriate, agreed-upon services. They are responsible for collaborating and coordinating care to enhance the patient experience from the date of initial referral through transplant hospitalization and for the duration of the post-transplant period and the achievement of collaborative goals. They collaboratively develop patient goals, monitor progress, address barriers to goal achievement, and evaluate outcomes of individualized care plans. This role provides training, patient education, referrals to community agencies, multidisciplinary team coordination, guidance, and mentors staff and physicians on managing complex psychosocial patient issues in line with the organizational academic mission.

PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:

• Provides psychosocial assessment of the individual and family, including limitations, deficits and strengths in their current situation and environment, as well as functional level. May conduct a psychiatric social work assessment according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Develops treatment plans with appropriate and competent interventions.
• Responsible for psychosocial assessment and intervention in crisis situations that often involve issues of suicide, homicide, family violence, elder or child abuse.

• Provides treatment, therapy, psycho-education and/or counseling utilizing individual, family or group modalities.
• Provides information, referral and creative resource acquisition for specific individual and family needs both within the Hospital and in the community as indicated. Assists patients/families to understand psychosocial factors impeding their maximal utilization of hospital and community resources.
• Collaborates with and provides psychosocial consultation to the health care team to promote a smooth, coordinated plan of care. Aids the team in understanding and integrating the significance of psychosocial factors in relation to patient's illness, treatment and recovery. Identifies psychosocial issues that may impede progress. Makes recommendations to the team regarding patient/family care and management. Assists health care team to assist patient/family level of understanding to make informed decisions.
• Provides outreach, case finding/screening for high-risk issues that may impact on patients progress, participation in plan, discharge or ability to utilize resources.
• Assists with discharge planning issues to ensure continuity of care. Formulates, coordinates and implements the psychosocial components of outpatient care.
• Consults, collaborates and communicates with a wide range of social, governmental and legal agencies, courts, schools, clinics, other hospitals, physicians and other sources.
• Provides on-call social work services for emergencies outside of working hours, e.g., evenings, nights and weekends.
• Serves as a patient/family advocate with a variety of systems both internally and externally as required. May be called upon to testify in court.
• Ensures clinical documentation is complete and according to departmental standards. Performs other administrative documentation and record keeping, such as accountability and statistical reports, billing forms, student intern evaluations, performance evaluations, etc. in complete and timely manner.
• Initiates policy and program development in specific service area or team, utilizing knowledge of state-of-the-art programs and promoting social work values such as patient self-determination and social justice. Initiates, participates in and supports policy and program development in the Department of Social Work Services.
• Actively engages in the regularly scheduled meetings, programs and activities of the Department. Serves on departmental committees. Represents the profession and Department in hospital and community meetings and committees.
• Participates in social work professional education, supervision and teaching activities; supervises or trains staff social workers, student interns, house staff, nurses, medical students, and volunteers as required.
• Continually monitors, assesses and modifies his/her own social work practice and programs. Conducts quality improvement activities and research regarding service delivery and effectiveness of interventions, as required.
• Conducts or participates in professional organizations, grant writing, teaching, public presentations, seminars and workshops. May supervise staff social workers, social work associates, social work interns, parent consultants, house staff, nurses, medical students and volunteers as required. Responsible for making recommendations to the Director of Social Work Services regarding service delivery gaps, systemic issues and program development.
• Maintains collaborative, team relationships with peers and colleagues in order to effectively contribute to the working groups achievement of goals, and to help foster a positive work environment
• Performs other similar and related duties as required or directed.
• Participate in SW billing program. This will include working with credentialing department to ensure proper credentialing guidelines are met. Maintain understanding of compliance guidelines to ensure a full understanding of billing process, billing expectations and proper documentation. Participation in billing program will be established and overseen by the Transplant and Social Work department.

Pre-Transplant Responsibilities

• Meet with patient/family on a regular basis to assess and provide emotional support. Offer supportive counseling to help patient/family cope with the waiting period, declining health, death and dying issues, and/or lengthy hospitalizations.
• Provide concrete services such as assistance with housing, transportation, and immigration issues. Provide information and referrals for disability and retirement benefits, medical insurance coverage, and other financial issues. Refer to community resources such as fund-raising foundations.
• Facilitate and/or refer patients and caregivers to transplant support groups, and coordinate mentoring programs.
• Make referrals to psychiatric/neuropsychiatric/psychological services as deemed necessary.
• Maintain ongoing communication with multidisciplinary team members.
• Obtain and monitor behavioral agreements from patients/families that address continued commitment to maintaining compliance with medical regimen, abstinence from nicotine, alcohol, illicit substance use.
• Provide patients with support surrounding end of life issues. Educate patients regarding Advance Directive forms and refer to palliative care when appropriate.

Post-Transplant Responsibilities

• Provide ongoing assistance with relocation housing needs, transportation, maintaining medical insurance, obtaining medications and support for the caregiver.
• Follow patient for psychosocial/mental health issues related to post-transplant adjustment (i.e. depression, marital or family issues, ETOH/substance abuse, changes in family. dynamics, concerns regarding rejection or body image). Facilitate referrals as needed.
• Assist with return to work issues.
• Provide support to transplant recipients as they explore feelings towards their donor and assist in the coordination for correspondence with donor family when desired.
• Evaluate all post-surgical transplant recipients and living donors before discharge to ensure their needs are met and collaborate with multidisciplinary team members as necessary.

JOB KNOWLEDGE AND SKILLS:

• Possesses and applies the skills and knowledge necessary to provide care to patients throughout the life span, with consideration of aging processes, human development stages and cultural patterns in each step of the care process.
• Knowledge of casework process and community resources in relation to health (including mental health), illness, and disability.
• Knowledge of current social work theory and practice, the ability to apply treatment and case management methods, and familiarity with community issues and resources.

• Understanding of organizational theory and practice in large systems and the knowledge of social and health care policies and systems.
• High degree of diagnostic, treatment, interpersonal, organizational, and communication skills.
• Analytical skills required assessing patient needs, to develop associated treatment modalities and to provide effective counseling.
• Computer skills and knowledge of general office programs, spreadsheet programs, database programs, and presentation programs (Word, Excel, Access, PowerPoint).

EDUCATION:

• Masters Degree in Social Work from an institution accredited by the Council on Social Work Education.

EXPERIENCE:

• 2-3 post Masters Degree social work experience.
• Transplant experienced desired but not required
• Epic experience desired but not required

An equivalent combination of education and experience, which provides proficiency in the areas of responsibility listed above, may be substituted for the above education and experience requirements.

LICENSES, ETC.:

• Licensure at the Licensed Independent Clinical Social Worker (LICSW).

AGE SPECIFIC COMPETENCIES:

Possesses and applies the skills and knowledge necessary to provide care to patients throughout the life span, with consideration of aging processes, human development stages and cultural patterns in each step of the care process. This includes:

• Knowledge of growth and development

• Ability to interpret age specific data and response to care
• Provide age specific communication

WORKING CONDITIONS/PHYSICAL DEMANDS:

• Normal office setting.
• Inpatient and/or outpatient clinic patient care area.

All your information will be kept confidential according to EEO guidelines.

AMERICANS WITH DISABILITIES STATEMENT:

Must be able to perform all essential functions of this position with reasonable accommodation if disabled.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Tufts Medical Center reserves the right to modify position duties at any time, to reflect process improvements and business necessity.

COVID-19 POLICY:

Please note that effective October 1, 2021, as a condition of employment at Tufts Medical Center, all employees and new hires must have received their complete dose of the COVID-19 vaccine, unless they have been granted an exemption.