The Licensed Social Worker’s primary responsibilities and qualifications are as follows but are not limited to:

Assesses the psychosocial status of patients and families/caregivers related to the patient's terminal illness and environment and communicates findings to the registered nurse and other members of the interdisciplinary group. Provides an assessment in the patient's identified residence and assistance when this is not safe and another plan is required.

Carries out social evaluations, including family dynamics, caregiver abilities, communication patterns, high risks for suicide, neglect or abuse and plans intervention based on evaluation findings. Counsels patient and family/caregivers as needed in relationship to stress, and other identified coping difficulties. Provides crisis intervention when necessary.

Assesses for, and educates interdisciplinary group, on any special needs related to the culture of the patient and family. Includes communication, role of family, space, and any special traditions or taboos.

Maintains clinical records on all patients referred to social work.

Point of Service documentation is an expectation of all clinical personnel for quality care, accuracy, and communication standards. The clinician is expected to appropriately document at Point of Service, have timely synchronization of patient data & effectively communicate with the Patient Care Team.

Educates patients and families on, and assists in, preparation of advanced directives.

Provides information and referral services for organization patients and families/caregivers regarding practical and environmental needs.

Provides information to patients and families/caregivers and community agencies.

Serves as liaison between patients and families/caregivers and community agencies.

Maintains collaborative relationships with organization personnel to support patient care.

Maintains and develops contracts with public and private agencies as resources for patient and personnel.

Participates in the development of the plan of care, involving the patient and family, and attends regularly scheduled interdisciplinary group meetings, assisting the team in recognizing the effects of the psychosocial stresses on the symptoms of the terminal illness.

Assists physician and other team members in understanding significant social and emotional factors related to health problems and death/dying issues.

Participates in discharge planning when needed. Assists patient and family/caregiver with securing durable power of attorney and with funeral arrangements, as needed.

Keeps supervisor informed of potentially problematic patient/family issues and significant changes in patient status.

Manages multiple priorities and demonstrates effective problem solving and decision-making.

Assumes responsibility for personal growth and development. Maintains and improves professional knowledge and skills through continuing education and in-services.

Participates in on call rotation to insure agency ability to provide 24 hour coverage.

Participates in agency QI Program.

Provide support to all agency patients including the Pediatric Palliative Care program.