CLASS SUMMARY:
Incumbent ensures continuity of directly provided and contractual services to agency's mentally ill, with possible co-occuring intellectual developmental disabilities and substance abusing client populations. Service Coordinators assist clients with their basic physical, financial, social and personal needs. Service coordination services for the client include outreach, psychological and need assessments, treatment planning and service provider linkage, monitoring, advocacy, counseling and crisis intervention, daily living support, medication supervision, and similar functions.
DISTINGUISHING ELEMENTS OF THE CLASS:
I. IMPACT: The general health and welfare of the client population served are directly dependent on the work of this position. Clients are mentally ill, intellectual developmental disabilities, substance abusing, homeless, HIV positive, incarcerated and/or institutionalized. The clients may also present multiple disabilities. The incumbent assesses need, plans treatment and refers clients to appropriate programming, and follows up to monitor client progress. Work includes mental status observations and recommendations. This class has the responsibility for advocating for needed services at the individual client level, as well as identifying generic needs in the services network. Finally, the Service Coordinator provides a variety of essential therapeutic and logistical services directly to the client which enables client care.
II. LATITUDE: A Service Coordinator performs on-going case work independently with only occasional consultation with their Manager. A Service Coordinator is expected to understand administrative and/or policy issues without individual consultation with their supervisor. Periodic review of records is made by the Manager and a peer team. Work is guided by detailed policies and procedures however the number and diversity of services and procedures involved require the incumbent to exercise considerable independent decision making.
III. RESPONSIBILITY FOR THE WORK OF OTHERS: None.
IV. INTERPERSONAL CONTACTS: Work requires continuous and involved interface involving advocacy and/or coordination of client services with a number and variety of others, internal and external, to the agency. These include: clients, client families and care givers, agency staff, contractual program staff, local social services and health agencies, physicians, attorneys, court personnel, police, jail personnel, hospital staff, residential treatment and vocational rehabilitation personnel, state and federal service agencies, school personnel, employers, landlords, community groups and organizations and legislators.
V. DIFFICULTY: Work involves assessment of client needs and the development of an original service plan specific to the needs identified. Work requires and involves integration or coordination of various services needed by the client. Work involves interaction with a multitude of professional disciplines, as well as requires the incumbent to personally render direct care ranging from crisis intervention to provision of basic shelter, food, or personal needs to supportive counseling. Incumbent works with hostile or aggressive clients and is called upon to de-escalate potentially explosive behaviors and situations. Lack of available resources requires use of creativity and innovation to deal with specific client needs, often in crisis situations. The case load of a Service Coordinator will generally contain the most difficult clients. Work may involve the assessment of HIV risk behaviors and the provision of appropriate intervention techniques needed to decrease risk behaviors while accurately assessing other client needs.
VI. COMMUNICATIONS: Constant oral communication by phone and in person with clients and other parties involved. Frequent standardized reports, correspondence and client service plans and summaries are written by incumbent. The incumbent may occasionally address community groups, peer groups and directors, managers, and coordinators in the agency.
VII. EQUIPMENT/FACILITIES RESPONSIBILITY: Incumbent frequently operates agency or personal vehicles to visit clients and contact community resources. Incumbent may also use mobile telephone equipment.
VIII. WORKING CONDITIONS: Work frequently involves traveling and visitation to client homes of varying sanitary and health (emotional and physical) conditions located in neighborhoods of varying security. Work may also take incumbent to homeless shelters, jails, and out-of-town locations. The incumbent is exposed to hostile and/or aggressive client behaviors presenting a personal risk of bodily harm. Incumbent is expected to respond during off hours to calls for assistance for clients for whom incumbent has primary responsibility. For those assessed at being high risk for HIV, this position will provide counseling and HIV testing referrals. For clients testing HIV positive, this position will provide crisis intervention, assessment of service coordination needs, transportation, home visits and referral services.
IX. KNOWLEDGES, SKILLS AND ABILITIES (KSA'S):
Thorough knowledge of interviewing and supportive counseling principles and techniques.
Thorough knowledge of social casework principles and techniques.
Thorough knowledge of community resources and programs and of regional and state resources for adults with mental illness.
Thorough knowledge of the symptoms, common behavioral and social characteristics and other manifestations of the disabilities affecting the client population served.
Thorough knowledge of human development and behavior.
Knowledge of HIV Infection and AIDS, including how infection may occur, risk assessment, prevention, treatment and progression of disease.
Knowledge of federal and state local support services and laws governing client's rights and confidentiality of records to include HIPAA and 42 CFR, Part 2.
Thorough knowledge of services required by individuals at high risk for HIV infection or are HIV positive or have AIDS.
Ability to evaluate and interpret behavioral observations.
Ability to establish and maintain rapport with client group and their families.
Ability to view and address the total spectrum of service needs.
Ability to maintain effective working relationships with other employees and representatives of various public and private agencies.
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 Virginia Driver's License.
XI. PRINCIPAL DUTIES AND RESPONSIBILITIES OF CLASS (ILLUSTRATIVE ONLY):
Meets with and interviews with clients, families and other care providers to assess client needs and eligibility of services, prepares mental status and social assessments and other client information summaries.
Develops treatment and service plans for clients. Makes and documents periodic reviews.
Participates in client review meetings and provides input into other service coordinators' cases.
Responds to requests for information about available services for mentally ill adult client populations.
Advocates needs of clients within and outside system, liaise between client, care givers and service providers.
Assists clients in obtaining basic resources such as: shelter, food, medical services, and disability benefits. Assists with client relocations.
Monitors client behaviors and progress and provides assistance to clients toward attaining pre-determined goals, schedules clients appointments, visits and observes residences and supervises medications compliance.
Provides supportive counseling to clients and client families, intervenes and provides emergency crisis counseling.
Makes client referrals to appropriate service providers and coordinates service delivery to client.
Participates in discharge evaluations and planning.
Prepares memos, correspondence, records and reports related to service coordination activities.
Consults with other agency professionals on difficult behavioral cases.
Attends and testifies at court hearings and other legal proceedings involving the client managed.
Develops and maintains a housing resource list.
Conducts HIV risk assessment for clients.
Coordinates services for persons who are HIV positive and have mental health, intellectual developmental disability and substance use disorder treatment needs.
Conduct on-site urine drug screening for clients with substance use disorders.
Does related work as required.
Transports 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, and handling, sitting, standing, pushing, and pulling.
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