*This position is located at the Hampton Roads Regional Jail CLASS SUMMARY: Works as a member of the Jail Based Behavioral Health Service Team at Hampton Roads Regional Jail (HRRJ). Work in collaboration with the HRRJ, local providers, community agencies and program participants to provide ongoing support to eliminate fragmentation, duplication or gaps in care and treatment. Enhance the quality of serious mentally ill inmate’s care coordination from within the jail environment and maintain involvement through an individual’s release from incarceration to community based services. Perform behavioral health consultation, screening, short-term targeted interventions and case management functions dedicated to transitional care and a seamless re-entry in treatment services in the community. DISTINGUISHING ELEMENTS OF THE CLASS: I.IMPACT: The incumbent’s work has immediate effect on the treatment and progress of the seriously mentally ill consumers who are in the regional jail who may present with other disabilities with co-occurring substance use disorders, intellectual developmental disabilities, homeless, HIV positive, and have a history of incarceration or psychiatric hospitalizations. The planner will provide clinical consultation to the case management supervisors and other agency clinical staff and work collaboratively to ensure effective and responsive services to the clients. In addition, the incumbent participates in the initial assessment of clients’ needs with serious mental health and co-occurring diagnosis required as a component of their clinical services and used as a basis for subsequent service planning and referral. The incumbent will provide direct short-term intensive clinical services to a small caseload of consumers following release from the regional jail until to transition to other clinical programs for ongoing needs. Finally, the incumbent ensures agency policy is followed and oversees disbursement of agency monies to support reentry needs. II.LATITUDE: Regular work is performed independently; however, incumbent serves as a member of a team discharge planners transitioning back into the community. Interaction with the immediate supervisor and Manager is primarily conducted 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 plans, grant requirements, agency policies, diagnostic manuals, and the standards of the profession. The incumbent is expected to understand administrative and/or policy issues without individual consultation with their Supervisor. Work is guided by established agency policies and procedures as well as procedures of the grant project agreed upon by four regional CSBs. Requires the incumbent to exercise considerable independent decision-making. III. RESPONSIBILITY FOR THE WORK OF OTHERS: Coordinates the provision of services to seriously mentally ill consumers receiving care at HRRJ in planning and implementing re-entry. 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 and personnel from the regional jail and other community services boards participating in the project. V. DIFFICULTY: Work involves life-and-death decisions by the incumbent in terms of the well-being of the clients and involves assessment of client needs and the development of service plan for entry back into the community from the regional jail. Work requires and involves integration or coordination of various services needed by client for reentry including coordination with a multitude of professional disciplines. 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 reentry plans 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. Incumbent works with hostile or aggressive clients and often requested to assist to de-escalate potentially explosive behaviors and situations. Lack of available resources requires use of creativity and innovation to deal with specific client needs. VI. COMMUNICATIONS: Incumbent will communicate effectively, in writing and orally to other professionals. Incumbent must also prepare client's reentry plans, reports, complex correspondence, tracking, and maintenance of data required by grant activity. Incumbent will prepare documentation of reentry and service linkage activity. Constant oral communication by phone and in person with clients and other parties involved and the regional jail. The incumbent may occasionally address community groups, peer groups and leadership with other CSBs and the regional jail and coordinators in the agency. 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 based out of the Hampton Roads Regional Jail (HRRJ) in Portsmouth, VA and the locality where consumer inmates are being released to. Work is frequently conducted at CSB office/clinic environments and includes frequent visits in the Hampton/Newport News community to client homes of varying sanitary conditions located in problem neighborhoods. Work may also take incumbent to homeless shelters, boarding homes, assisted living facilities, hotels and to appointments and intakes at social services or treatment facilities. The incumbent is exposed to unhealthy, emotionally unstable, hostile and/or aggressive clients presenting a risk of personal harm. Incumbent may be frequently interrupted during off-duty hours with work related calls. IX. KNOWLEDGES, SKILLS AND ABILITIES (KSA'S): Thorough knowledge of interviewing and clinical assessment skills relevant to the client population served. Thorough knowledge of community resources. 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 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 DSM5. Demonstrate ability to plan and use effective interventions for persons with mental illness and/or substance use disorders Knowledge and understanding of the addiction process. Strong oral and written communication skill. Knowledge of SSI/SSDI application process Knowledge of Medicaid/Medicare application process Ability to maintain accurate documentation within electronic health record Knowledge of community resources available to inmates Ability to establish and maintain effective working relationships with others. Ability to establish and maintain rapport with the client population served. Ability to prepare and maintain narrative and statistical records and to related reports. Ability to problem solve, be well organized and demonstrate to be highly motivated. X. LICENSURE: Valid Virginia Driver's License. XI. PRINCIPAL DUTIES AND RESPONSIBILITIES OF CLASS (ILLUSTRATIVE ONLY): Serves as liaison between HRRJ and the CSB. Interviews inmates, collects and completes required documentation and determines eligibility for referrals. Make treatment recommendations and appropriate referrals based on assessment. Establish a realistic Discharge Plan for each inmate with SMI To individuals who meet the DBHDS SMI standards, provide forensic discharge planning services using the AIC and RNR models of case management. Regularly meet the assigned SMI inmates to coordinate care and discharge planning. Consults with HRRJ and their contracted Medical/Behavioral Health Provider, C.O.R.E Program, other participating community services boards and agency staff for the coordination of complete discharge/reentry planning. Coordinates with HRRJ, current and designated placements to insure optimum re-entry and transition. Schedule and assist individuals in attending appointment at their home CSB for intake and establish linkages for services. Assist inmates with scheduling, attending and independently maintain post discharge psychiatric intake and medication evaluation appointments. Assist clients in arranging and/or providing transportation for services at their local CSB as needed. As appropriate, assist clients to set and keep appointments and link inmates with SMI with entitlements. Establish stable housing for each eligible SMI inmates at discharge. Attend monthly meetings with partners to report on administrative and programmatic updates Conducts assessments of inmate needs by providing basic case management services. Provide overall service coordination, referral, linkage and advocacy to inmates with varying needs. Perform duties in concert with other members of the team. Serve as an advocate on behalf of the inmate by making appropriate referrals to other social services, education and health agencies as needed. Monitors, tracks data and outcomes and documents client behavior in accordance with established policies. Participates in the allocation and monitoring of expenditures for consumer reentry needs through the C.O.R.E program. Represents agency on the C.O.R.E and DBHDS Discharge Planning Committees and Forensic Advisory Team at HRRJ. Provides non-violent crisis intervention for clients as needed. 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. Performs Restoration Services as appropriate. Performs job related duties as required. 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. XIII. DRIVING REQUIREMENTS: Valid Driver’s License. Transports clients as necessary. |
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