ANDREA MATHLIN

cuRRENT: sOCIAL WORKER/COORDINATOR/ asst. social services director

Responsibilities:

• Responsible for assisting the Director of Social Services in identifying, providing/arranging medically related social services and counseling to assist the residents of the Continuing Care Retirement Communities (CCRC) to attain or maintain their highest practicable physical, mental and psychosocial well-being during their stay in the nursing home and in planning for discharge.

Administrative Functions:

• To maintain a caseload and deliver Social Services within the Health Center in compliance with state and federal regulations. 
• To participate in the QIS survey process in the Health Center.
• To maintain contact information and current certification status for all private duty CNAs employed to work in the Health Center.
• Performs the duties of the Director of Social Services in her/his absence.
• Maintains professional medical processes and records according to ACHA.

Social Service Functions: 

• Complete MDS assessments/processes.
• To identify resident and family concerns related to discharge planning, adjustment to illness or setting and actively initiate and participate in Interdisciplinary care conferences.
• To provide counseling to families and residents and emotional support/orientation and/or make appropriate referrals to community-based and/or inhouse providers.
• To participate in the admission and/or pre-admission process, as appropriate.
• To document a resident centered comprehensive social assessment, social history and progress notes for Health Center residents on caseload that identify resident’s support system, strengths and needs, as well as goals and actions to assist resident in achieving highest practicable level.
• To provide end of life support, education, grief/bereavement counseling to residents and families.
• To provide discharge planning and post discharge referrals for Health Center residents.
• To assist the resident or family with the preparation of and/or understanding of Advance Directives.
• To welcome new residents and act as liaison with interdisciplinary team, including problem solving, complaint resolution and adjustment to setting.
• Works directly with Health Center Residents, their relatives, family and friends by aiding in their adjustment, handling their complaints, understanding their behavior and meeting their needs.
• Makes daily rounds through the Health Center, visiting residents and families and making observations regarding resident/family adjustment and determining discharge needs.
• Assists Independent and Assisted Living residents with resources and ancillary services.
• Will observe for changes in psychosocial needs and possible transition to different level of care.
• Conduct weekly transition meetings.
• Works closely with in-house psych services to arrange for referrals and monthly meetings.
• Facilitate support groups for grief and Alzheimer’s Association.

Staff Development Functions:

• To provide In-service education regularly to small or large groups on requested topics.

Health Center Residents’ Rights Functions:

Assures that the residents’ rights to fair and equitable treatment, self-determination, individuality, privacy, property and civil rights (including the right to register complaints) are well-established and always maintained.

Assists in ensuring that each of the Health Center residents, or the residents’ legally appointed guardian, is furnished with a copy of the Residents’ Bill of Rights.

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Activities therapist

Responsibilities:

• Assess the specific activity needs of patients and record their progress, customizing group activities to cater to a wide range of diagnoses including schizophrenia, bipolar disorders, PTSD, depression, anxiety and substance abuse.
• Teach psycho-education in groups using CBT/DBT. Coping skills and life skill topics such as communication, boundaries, anger management, grief support, and emotional regulation through meditation and art were implemented and successful.
• Facilitate the integration of patients with mental health disabilities into the community by instructing on the use of community resources and recreational activities.
• Enhance and sustain the physical, mental and emotional health of clients in Baker Act facilities.
• Implement Cognitive Behavioral Therapy (CBT) and coping skills to help reduce patients’ depression, stress and anxiety.
• Maintain timely and accurate charting for each therapy session, covering both individual and group sessions.
• Monitor and document patient progress towards treatment goals, ensuring the maintenance of precise records.
• Conduct evaluations of the effectiveness of activities and therapy groups.
• Offer assistance and support to fellow staff members in a team-oriented environment.

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interim team manager + therapist discharge planner

Interim Team Manager

• Acting team manager for interdisciplinary staff during understaffed period, providing Director with status of caseloads, documentation, and reporting. 
• Working across units in building as needed. 
• Liaison between frontline staff, management, physicians, and patient’s families to ensure clear, concise, and timely communication across all levels. 
• Identified, provided and arranged medically related social services and counseling to assist clients.
• Resource management and staff development; reporting needs to administration on staffing schedules, and trainings for new discharge planners. 
• Patient care oversight; monitoring and completing patient treatment plans to support clinical decisions. 
• Represent the hospital in mental health court to discuss clients’ Baker Act legal status and advocate for their long-term treatment goals. 

Therapist Discharge Planner

Responsibilities:

• Maintain a calm, therapeutic environment for clients with high acuity care needs and a variety of diagnoses, including schizophrenia, bipolar disorders, PTSD, depression, anxiety and substance abuse.
• Assist psychiatric inpatient clients in achieving and maintaining stability within the Baker Act facility through a variety of essential functions.
• Conduct group and individual therapy sessions to facilitate mental health improvement.
• Identify clients’ placement needs and connect them with supportive resources.
• Perform interviews with clients to complete psychosocial assessments and develop treatment plans focusing on immediate discharge goals.
• Document all client-related activities efficiently in the EHR systems my Avatar Welligent.
• Engage in activities with clients, their families and/or significant others to support treatment processes.
• Provide input into treatment plans and collaborate with treatment team providers, offering support and crisis intervention as needed.
• Uphold high standards of ethical and professional conduct, adhere to agency policies and procedures and ensure HIPAA compliance.

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