Job Description

POSITION SUMMARY: Under supervision of Program Management, performs duties in support of therapeutic services and provides comprehensive direct support services which are structured to meet the needs of an adult population composed of SMI, dual-diagnosed and/or referred persons. Implements services to members in accordance with their individualized service plan; communicates and documents member’s progress toward their recovery; coordinates and monitors rehabilitation-related services for members with serious mental illness; performs related duties as required.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

  • Works collaboratively with the clinical team to engage, educate, communicate, and coordinate care with member, their family, behavioral health, medical and dental providers, community resources and others in ensuring that all services prescribed in the individualized service plan are implemented.
  • Utilizes evidence-based practices, such as the Boston University Intensive Psychiatric Rehabilitation Program Team Approach (IPRPT) to assess the member’s needs including living, learning, working, and social leisure goals and assist members on assigned caseloads to reach their desired role achievement in any or all of these environments.
  • Provides supportive services including, but not limited to, the following:
    • Assistance in maintaining, monitoring and modifying covered behavioral health services;
    • Brief telephone or face to face interactions with a person, family or other involved party for the purpose of maintaining or enhancing a person’s functioning;
    • Assistance in finding necessary resources other than covered services to meet basic needs;
    • Serves as a point of contact and to ensure ongoing collaboration including the communication of appropriate clinical information with other involved parties as appropriate and coordination of care with a person’s family, behavioral and general medical and dental health care providers, community resources, and other involved supports including educational, social, judicial, community and other State agencies;
    • Ensures the provision of all covered services identified on the service plan; referrals to community resources as appropriate and coordination of care activities related to continuity of care between levels of care and across multiple providers, services and supports;
    • Provides outreach and follow-up of services including, but not limited to, crisis and missed appointments to ensure adequate resources are available and in place;
    • Participates in staffings, case conferences or other meetings with or without the person or his/her family participating;
    • Screens and assesses all persons on caseload for financial entitlements (AHCCCS, SSI/SSD etc.); completes AHCCCS applications on all members on caseload meeting criteria;
    • Provides transportation to member as appropriate and determined by the clinical team;
    • Ensures that transfers to out-of-area, out-of-state or to an Arizona Long Term Care System (ALTCS) contractor, are coordinated as applicable;
    • Ensures the development and implementation of transition, discharge and aftercare plans prior to discontinuation of behavioral health services.
  • Collaborates with the person and his/her family or significant others to implement an effective service plan, explaining the available clinical options to the team, including the advantages and disadvantages of each option.
  • Maintains the person’s comprehensive clinical record, including documentation of activities performed as part of the service delivery process (e.g., assessments, provision of services, coordination of care, discharge planning).
  • Provides continuous evaluation of the effectiveness of treatment through the ongoing assessment of the person and input from the person and relevant others resulting in modification to the service plan as necessary.
  • Pursues best practice outcomes for person with mental illness including continuing education, employment, independent housing and community tenure.
  • Educates team members as the subject matter expert regarding rehabilitation and vocationally related issues and provides ongoing technical training and support to the team as requested or indicated including updates on available community resources, how to utilize the services of the co-located RSA/VR counselor or co-located vocational providers.
  • Provides guidance, assistance and support to the clinical team for non-priority population members as part of the completion of ISP’s and assessments.
  • Documents individual recommendations and provides signatures on assessments and ISPs for all Priority Population members.
  • Conducts an “Orientation to Rehabilitation Services” bi-monthly to the assigned clinical site(s).
  • Develops relationships with community employers, providers or other organizations to foster an increase in employment and meaningful community activity opportunities for members.
  • Provides individual and group guidance in identified areas of need as determined by assessments including, but not limited to, the IPRPT model utilizing the Readiness Assessment, Functional Assessment, and Skill Development Modules and tools.
  • Assesses, documents, and provides the appropriate level of support and skill needed to assist the member to maintain or achieve their living, learning, social, leisure goals.
  • Provides continuous evaluation of the effectiveness of treatment through the ongoing assessment of the person and input from the person and relevant others resulting in modification to the service plan as necessary.
  • Pursues best practice outcomes for person with mental illness including continuing education, employment, independent housing and community tenure. 

Skills / Requirements

EDUCATION/LICENSE/CERTIFICATION/EXPERIENCE REQUIREMENTS

  • A High School Diploma/GED and three years behavioral health experience; OR
  • An Associate’s degree and two years behavioral health work experience; OR
  • Bachelor’s degree in non-behavioral health related field one year behavioral health work experience; OR
  • Bachelor’s degree in a behavioral health related field; OR
  • A combination of Certified Psychiatric Rehabilitation Practitioner (CPRP) certification and one year of behavioral health work experience; in a rehabilitation setting preferred

 

Important Notes

Lifewell Behavioral Wellness is a non-profit behavioral healthcare agency providing treatment, services and support for low-income clients diagnosed with serious mental illness (SMI), general mental health issues and substance abuse disorders. Lifewell offers residential, outpatient, community living and psychosocial rehabilitation programs which are client centered and adapted to address a broad range of needs.

Lifewell programs provide safe and supportive environments that foster recovery, healthy living and personal growth for clients as they build on existing strengths, focus on addressing deficiencies, and learn new social and vocational skills.