CLASS SUMMARY: This class provides clinical consultation to staff of the Adult Mental Health Case Management Program and assists in the assessment, treatment planning, crisis intervention, referral and follow up to seriously mentally ill adults who receive treatment at Eastern State Hospital (ESH), Central State Hospital or a local psychiatric hospital. The discharger planner ensures that adult consumers of mental health services receive timely access to the CSB’s system of care and support that are responsive and consistent with service plans. The discharge planner will provide a central point of information regarding CSB services for ESH staff, Central State or local psychiatric hospitals. Clinical services will be determined by the intensity of consumer needs. The discharge planner will serve as liaison between the hospital and the community programs and will provide services including clinical assessment and utilization management, outreach, treatment planning, service provider linkage, short term monitoring, advocacy, crisis intervention, daily living support, and medication supervision. DISTINGUISHING ELEMENTS OF THE CLASS: I. IMPACT: The incumbent’s work has immediate effect on the treatment and progress of the consumer. The planner will provide clinical consultation to the case management supervisors in the community and will work collaboratively with the case management staff to ensure effective and responsive service to the clients. In addition, the incumbent may participate in the initial assessment of clients who require evaluation and diagnosis as a component of their clinical services. Assessments by the incumbent are used as a basis for subsequent service planning and referral. The incumbent may also provide direct short term intensive clinical services to a small caseload of consumers. Identification of needed programs, policies and procedures are the responsibility of the discharge planner. Finally, the incumbent ensures agency policy is followed and oversees disbursement of agency monies. II. LATITUDE: Regular work is performed independently. Interaction with the immediate supervisor, the Manager of Case Management Services, is only through regularly scheduled bi-monthly management meetings and on an ad-hoc basis as determined by the class incumbent. Work is guided by the comprehensive discharge and individualized service plan, federal and state regulatory boards, agency policies, diagnostic manuals, and the standards of the profession. The incumbent conducts periodic review of case records. The incumbent is required to use substantial independent judgment as available guidance is very broad. III. RESPONSIBILITY FOR THE WORK OF OTHERS: Coordinates the provision of services to consumers receiving care at ESH, Central or a local psychiatric hospital with all components of the CSB’s system of care. IV. INTERPERSONAL CONTACTS: Work requires direct and continuous contacts with consumers and involved or potential services providers. The incumbent interfaces with a variety of others, internal and external to agency. These include: clients, client families and care givers, agency staff, contractual program staff, local social services and health agency staffs, physicians, attorneys, court personnel, police, hospital staff, vocational rehabilitation personnel, state and federal service agencies, landlords, community groups and organizations and legislators. V. DIFFICULTY: Work involves life-and-death decisions by the incumbent in terms of the well-being of the clients. Emergency situations involve the application and interpretation of diagnostic norms and therapeutic standards to clients with a wide range of mental disorders. Assessment involves acute observation and analysis of current and historical behavioral presentations, medical and social histories and mental status data. Development of a comprehensive treatment plan requires knowledge of diagnostic issues, long and short term goals, resources and history. Consultation requires ability to provide accurate needs assessment and extensive knowledge of resources. Work requires the balancing of administrative expectations, client needs and ethics and standards of the agency and profession. VI. COMMUNICATIONS: Incumbent will communicate effectively, in writing and orally to other professionals. Incumbent must also prepare client's service plans, reports and complex correspondence. Incumbent will prepare monthly reports of discharge activity. VII. EQUIPMENT/FACILITIES RESPONSIBILITY: Incumbent operates an agency or personal vehicle to visit or to contact community resources. Incumbent will also use mobile telephone equipment and pager. Must be well-versed in the use of Windows-based personal computer business software applications. VIII. WORKING CONDITIONS: Work is performed in a hospital setting or typical office environment and also includes frequent visits to client homes of varying sanitary conditions located in problem neighborhoods. Work may also take incumbent to homeless shelters, jails, and out-of-town locations. The incumbent is exposed to unhealthy, emotionally unstable, hostile and/or aggressive clients presenting a risk of personal harm. Incumbent is frequently interrupted during off-duty hours with work related calls. IX. KNOWLEDGE, SKILLS AND ABILITIES (KSAs): Thorough knowledge of interviewing and clinical assessment skills relevant to the client population served. Thorough knowledge of community resources. Thorough knowledge of counseling practices, theories and techniques of counseling and ethical issues in counseling. Skilled at developing individualized, creative, behaviorally specific, time oriented treatment plans and behavioral contracts. Thorough knowledge of mental health and substance abuse case management programs and services. Thorough knowledge of Medicaid State Plan Option. Thorough knowledge of local, state and regional resources and programs for the seriously mentally ill, intellectual developmental disability and substance abusing population. Thorough knowledge of human development and behavior. Thorough knowledge of the symptoms, common behavioral and social characteristics and other manifestations of the disabilities affecting the client population served. Ability to observe, evaluate and interpret behavior and to form accurate diagnostic impressions using the DSM IV. Ability to establish and maintain rapport with the client population served. Ability to view and address the total spectrum of service needs. Ability to establish and maintain effective working relationships with others. Ability to communicate effectively and prepare related documentation. Ability to prepare and maintain narrative and statistical records and to prepare related reports. X. LICENSURE: Valid VA Driver's License. XI. PRINCIPAL DUTIES AND RESPONSIBILITIES OF CLASS: Facilitate discharges from State Hospitals. Consults with ESH, Central State or local hospital staff for the coordination of complete discharge planning and after-care coordination. Coordinates with current and designated placements to insure optimum transition. Serves as liaison between ESH, Central State or local psychiatric facilities and the CSB. Administers mental status evaluations and client assessments. Make treatment recommendations and appropriate referrals based on accurate assessment. Develops client service plans. Provides crisis intervention. Monitors and documents client behavior in accordance with established policies. Provides client advocacy and related activities. Participates in the allocation of consumer funding for after care services through the Discharge Assistance Program (DAP). Represents agency on the Regional Discharge Assistance Committee (REDAC). Provides non-violent crisis intervention for clients as needed. Coordinates requests for exchange of information to assure protection of client confidentiality. Assists community case managers with complex cases and situations. Coordinates for the collection of program outcome data through measures of consumer satisfaction, program efficiency and effectiveness. Assists in the assignment of cases to program clinicians. Coordinates team plans and programs with divisional objectives. Participates in the selection and training of program staff. Prepares and conducts staff orientation and training. Participates in inter- and intra-agency team and management meetings and coordinates the implementation of policy and procedure change at the division level. Interacts with law enforcement staff, judicial personnel, health providers, and other service providers to facilitate services. Develops, recommends and implements program, policy and procedure changes. Monitors expenditures and authorizes the disbursement of program funds. Performs job related duties as required. Transport clients as necessary. XII. PHYSICAL REQUIREMENTS: Must have the use of sensory skills in order to effectively communicate and interact with other employees and the public through the use of the telephone and personal contact as normally defined by the ability to see, read, talk, hear, handle or feel objects and controls. Physical capability to effectively use and operate various items of office related equipment, such as, but not limited to a, personal computer, calculator, copier, and fax machine. Some walking, moving, carrying, climbing, bending, kneeling, crawling, reaching, handling, sitting, standing, pushing, and pulling. |
Click here for technical assistance.
.jpg)