Community Health Worker - Lead

Community Health Worker - Lead-(3302912)

Description

LEAD COMMUNITY HEALTH WORKER/ FULL TIME/ 40 HOURS/ BOSTON

GENERAL SUMMARY

The Community Health Worker Lead (CHW-L) position requires the ability to be self-directing, outgoing, professional, organized, and goal oriented. The CHW-L will support, develop, and motivate CHW team and help grow the effectiveness of the CHW program in the Department of Psychiatry. This role also promotes patient advocacy, patient-centered approach, and identify internal and external cross-program opportunities and strategies.

A Community Health Worker (CHW) is a trusted member of the community who helps patients better access and coordinate their psychiatric care. We believe that CHWs have the skills and experience to understand what patients are going through and help them address the social and psychiatric barriers that lead to poor health. The goal of a community health worker is to assist the most high-risk patients with the tasks of getting psychiatric/medical care, working on health goals, and to help them deal with the “real-life” issues that keep them from staying healthy. Although a CHW role is not in a clinical position, it requires the capacity to learn basic clinical concepts in order to identify when a referral to a licensed clinician appropriate and how psychiatric teams work together to achieve best possible health outcomes.

The CHW-L will work with patients receiving care at Brigham and Women’s Hospital outpatient psychiatric clinic. CHWs are integrated into the outpatient psychiatric team, serving as a bridge between the team and patients in the community. As a CHW in our department, you will develop trusting working relationships with your patients and be supported by a psychiatric team that includes social workers, nurses and psychiatrists.

PRINCIPAL ROLES AND RESPONSIBILITIES

Provide community health work services for patients identified as high-risk due to psychiatric or psychosocial challenges including:

Community resource navigation to address social determinants of health

• Support community resource finding related to Social Determinants of Health needs, including housing, food, transportation, utilities, medication costs, elder care, childcare, job search, and education needs.
• Provide education and accompany patients to appointments when needed to provide support and advocacy.
• Meet patients in the community or conduct “porch” visits when and where appropriate to follow up on key aspects of the patient’s care to assess in-home barriers and engage patients in addressing barriers.
• Assist patients fill out applications for community services such as Medical Assistance, SNAP (Supplemental Nutrition Assistance Program), Social Security Disability Insurance (SSDI), Department of Mental Health (DMH).
• Provide advocacy, patient education, and support – including accompaniment – in accessing community-based and hospital-based programs.

Intensive case management and in-person support to enable patients to access appropriate care, services, benefits, and programs.

• Work with patients and providers to set goals for patient’s care and motivate patients to meet their health goals.
• Work in partnership with the patient to identify and address barriers to care.
• Provide culturally sensitive and responsive services to patients from diverse cultures and communities.
• Support the patient to further develop systems within their environment to assist with the overall management of their care.
• Co-develop strategies to reduce logistic barriers to care, such as, scheduling conflicts, childcare needs, and transportation that would prevent a patient from attending appointments, tests, treatment, etc.
• Assist patients in organizing their records, making follow up appointments and filling their prescriptions as needed.
• Refer to internal or external care management services when other issues are identified (i.e., food insecurity, domestic violence, etc.
• Participate as an integral part of the patient’s primary psychiatric care team.
• Attend initial and continuing education training programs including self-directed reading and in-person and online learning.
• Maintain regular communication with the patient’s provider and provider’s care teams through health record database, emails, phone calls and case review meetings
• Document each patient encounter in detail in the health record database. Track progress toward goals.
• Work with providers and their teams to reinforce health education messages – the importance of follow-up care, medication adherence, routines of self care, etc.
• Develop and maintain a strong working relationship with the clinic-based care team, including schedulers, practice assistants, nurses, medical interpreters, and others.

CHW Lead will spend approximately .50 FTE contributing to program development, team development and CHW support. This includes:

• Conduct administrative tasks, supervision, and at-the-elbow support for up to 5 CHWs
• Onboard and train new CHW hires
• Conduct chart reviews for each CHW using a grid to support CHW in providing high quality care and maintaining appropriate documentation
• Identify areas for shared barriers or obstacles across the team, knowledge gaps for team-based educational opportunities, and highlighting individual CHW’s strengths and successes for ongoing team capacity-building and celebration
• Co-lead the weekly CHW team meeting by drafting agenda, preparing slides, preparing presenters, facilitating, taking notes, summarize and share out agreements and next steps
• Compile and maintain the resource database and regularly update staff on new information
• Participate in leadership team meetings as needed

Qualifications

QUALIFICATIONS

• 3-5 years experience working as a patient navigator/community health worker, 5+ years of equivalent experience in healthcare or human services field, or outpatient clinical care experience.
• Associates Degree, Bachelor’s Degree preferred.
• High school degree required.
• Demonstrated experience successfully working with diverse and historically underserved populations.
• Experience working across interdisciplinary teams to improve patient’s health and wellness.

SKILLS/ABILITIES/ COMPETENCIES REQUIRED:

• Knowledge of community-based program services, public benefits, and other resources.
• Excellent communication skills.
• Strength in authentically connecting with people from all walks of life with empathy and humility.
• Ability to listen and connect with people from all walks of life.
• Strong attention to detail and prioritization.
• Familiarity and willingness to learn service approach models (e.g., trauma informed, cultural humility, strength-based, and others).
• Strong time management and planning skills.
• Ability to make connections across internal and external teams of care.
• Experience or strong interest in developing leadership skills and building a culture of excellence and teamwork.
• Excellent organizational skills given coordination of multidisciplinary team, various logistical components, data acquisition.
• Ability to work well within a team and independently.
• Computer skills: working knowledge, familiarity with using databases, comfortability with use of emails and some excel.
• Willingness to learn and further develop skills reflective of best practices and trends in the field.
• Spanish language skills preferred but not required.

WORKING CONDITIONS:

• Need to be able to work from home, office, and community. Position requires traveling to and from visits and meetings requiring reliable source of transportation.