Job Description

Job Description

Job Description

THE CHILDREN’S CENTER OF THE ANTELOPE VALLEY
Community Health Worker- JCOD Care Management (JCM)

Hiring Details

Department: JCOD Care Management (JCM), formerly the Reentry Intensive Case Management Services (RICMS) program

Reports To: Program Manager

FLSA Status: Non-Exempt (Full Time)

Job Overview

Community Health Workers serve as the primary agents of change for the JCOD Care Management (JCM), formerly known as (RICMS) and are supported by and report directly to a Program Manager and/or a Licensed Clinical Social Worker. They provide connections to direct services; care coordination and system navigation; coaching and social support; education about the health and social service system; advocacy; outreach; assessment; and capacity building. Additionally, they serve as liaisons and cultural mediators, continuously educate members of the health and social service system about community strengths, and needs, and may participate in research and evaluation about the JCM Program.

Essential Duties and Responsibilities (Included but not limited to):

OUTREACH AND REFERRALS

• Receive referrals directly from County jails (Pre-Release), the probation department, JCOD Support Center (Pre-Trial), JCOD D.O.O.R.S and the community and enroll individuals into the Care Management program

• Follow up with participants to support them with addressing their service needs to improve their health and well-being and prevent recidivism;

• Facilitates connections to a wide range of supportive services, including social services, physical and mental healthcare, housing assistance, employment and educational programs, cognitive behavioral interventions, substance use disorder treatment, and parenting and childcare resources.

• Connect and engage participants in activities and services.

• Build and maintain trusting and open relationships with community organizations, leaders, and resources.

ASSESSMENT

• Collaborates with the referring agencies to assess individual service needs and provide input to inform reentry case plans.

• Conduct additional assessment of participant strengths and needs. This includes but is not limited to administering appropriate screening and/or assessment tools.

• Guide participants, participants' significant others, and other team members in the development of a services and support plan, which addresses the participant's goals and any medical, behavioral health and/or substance use treatment needs.

• Assist participants in setting goals related to housing, benefits establishment, employment and self-sufficiency, childcare support, behavioral health treatment, and other topics which support the program participant in gaining more control over their lives and their health

• In conjunction with other team members and each participant, assist with evaluating progress towards goals and make adjustments in the case management plan to facilitate progress toward goals.

• Assess participant eligibility/suitability for special programs.

• Complete all necessary and required documentation, which includes use of a Case Management Platform, known as CMS.

• Compile and report summary program data during weekly check-in calls, assessments, and quarterly meetings.

• Maintain participant confidentiality and privacy by protecting participant health information.

COACHING AND SOCIAL SUPPORT

• Establish a trusting and open relationship with participants.

• Accompany participants to appointments as needed and appropriate.

• Help participants to build social support systems; this includes connecting participants to support and recovery groups.

• Provide coaching for housing, employment, and other interviews and address participants' anxieties related to these activities.

CARE COORDINATION, CASE MANAGEMENT, AND SYSTEM NAVIGATION

• Provide intensive case management for a determined period of time.

• Provide warm hand-offs and supported referrals to necessary supports and services, including housing, education, employment, substance use treatment, etc.

• Engage with participants in the most appropriate and accessible location, which may include: the street, participants' homes, the hospital, or other community sites

• Connect participants to needed resources within the Departments of Health Services, Mental Health and Public Health, and other health and social service providers

• Link participants to other Community Health Workers working at the family, group, community, and policy levels

• Arrange or provide transportation to services as needed

• Assist with obtaining, completing, and submitting applications, and appeals processes

• Support participants to prepare for and complete needed medical and social service appointments

• Facilitate connection to and engagement with a geographically and culturally appropriate primary care home

• Assist with discharge planning as appropriate

• As needed, assist other members of the health and social service team in identifying and securing appropriate community-based residential placements such as board and care, skilled nursing, substance use treatment or mental health treatment facilities for participants

• Arrange for supportive services such as home health care, in home supportive services, or durable medical equipment as needed

• Link participants experiencing homelessness to the Coordinated Entry System (CES)

• Assist participants to make a solid connection to another source of support before termination of the Department of Health Services' Office of Diversion and Re-entry (ODR) RICMS services

CULTURAL MEDIATION AND EDUCATION OF THE HEALTH AND SOCIAL SERVICE SYSTEM

• Assist participants, families, and significant others in understanding the RICMS program, and gaining their acceptance of and participation in the program

• Continue to follow-up with participants to encourage engagement and ongoing participation in and commitment to the program

• Build trusting relationships and collaborate with other members of the team who may include social workers, nurses, physicians, psychiatrists, service providers, etc.

• In both formal and informal settings, educate and inform other health and social service professionals about strengths and needs, as well as cultural worldviews, experiences and perspectives of the community or communities in which the CHW lives and works

• Work with other team members especially at a regional level to adapt systems and services to be more culturally centered and appropriate

• Participate in all program meetings, site-specific all staff meetings, and team huddles as directed by the Supervisor

• Respectfully and professionally represent the JCOD Care Management Program

ADVOCACY

• Serve as an advocate on behalf of the participant within clinical and community­ based settings to help participant achieve health and life goals and to secure necessary services and supports, promoting participant's recovery

• Assist the participant to learn to advocate for him/her/themselves

OTHER DUTIES AS ASSIGNED

• Complete assignments and other duties as delegated in a competent and timely manner

• Assure that all County guidelines and criteria are met

• Communicate clearly, professionally, and effectively with fellow CHWs and all site­ specific colleagues

• Attend all required trainings and events organized by the County to foster learning and community

Education and/or Experience

• Must be at least 18 years of age and hold a High School diploma or GED.

• Excellent organization skills and attention to detail.

• Intermediate level PC skills required, including a working knowledge of Word processing, spreadsheets, and Excel.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Noise Level: Usually Moderate

Environment: Office, or in the field. Fast-paced clinic with the expectation of flexibility in the workday

Work Hours: Usually standard business hours, but some evening and weekend hours, as needed

Physical Demands

While performing the duties of this job, the employee is regularly required:

• Frequently sit, stand, walk, stop, kneel, and crouch, regularly talk and hear.

• Frequently use hands, and fingers to handle or feel.

• Occasionally lift or move up to 25 pounds.

• Specific vision abilities required include close vision, distance vision, color vision, and peripheral vision.

• Depth perception and the ability to adjust focus.

• Ability to drive surface streets and highways.

This description is intended to describe the general nature and level of work being performed. It is not an exhaustive list of duties, responsibilities, and requirements of a person so classified. Other functions may be assigned and management retains the right to add or change the duties and responsibilities at any time.

Job Tags

Full time, Work at office, Trial period, Weekend work, Afternoon shift,

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