-Providing support to patients and their loved ones facing life-limiting illnesses and at end-of-life-Member of interdisciplinary team providing crisis intervention; symptom management; individual, family, group, bereavement, and end of life counseling; and providing timely and appropriate discharge planning based on known or anticipated needs, including hospital to hospice disposition planning-Providing twice a month coaching to second and third year internal medicine residents about palliative care discharge options as part a palliative care quality improvement project

-Assigned to Cardiothoracic ICU (CTICU) and Surgical ICU (SICU) units-Provided complete psychosocial assessments; crisis intervention, individual, family, group, bereavement and end of life counseling

Gained skills necessary to educate and advocate for patients and families to enhance their ability to make informed decisions regarding medical care, discharge planning, advance directives and end of life care through site visits, facilitated conversations, and opportunities to practice conversation skills within a multi-disciplinary group

-Demonstrated the ability to identify, assess, counsel and effectively serve psychosocially complex families with the ability to understand complex dynamics related to the family’s situation through the triaging of crisis-related phone calls -Completed psychosocial assessments at intake that included social, economic, cultural, age-related and behavioral factors, history of child, domestic abuse, prior psychiatric or substance abuse treatment, family and social support systems and all other available resources as appropriate to the family’s situation that were then used to develop individual service plans for each child in the client family-Provided accurate, timely and appropriate documentation of all activities per regulatory policies and procedures via daily, intake, admission, and discharge records

-Monitored and evaluated the plan of care, options and available services to effectively meet the client’s needs by conducting home and community visits and reassessed the plan of care by presenting new information at daily case team meetings.-Demonstrated appropriate professional practice by maintaining social work ethics within an interdisciplinary team model, as well as the ethical guidelines required for the role of either guardian ad litem or counsel for the client -Collaborated effectively with clients and relevant community resources to develop and implement an individualized plan of care by maintaining working relationship with agencies relevant to client’s needs

-Demonstrated expertise in providing resource specific information to resource families by developing and conducting a resource parent training on ambiguous loss -Maintained an extensive knowledge of federal, state and local assistance programs and community resources relevant to resource family needs by attending various agency trainings and meetings with community provider agencies

-Demonstrated expertise in providing resource specific information to resource families by developing and conducting a resource parent training on ambiguous loss -Maintained an extensive knowledge of federal, state and local assistance programs and community resources relevant to resource family needs by attending various agency trainings and meetings with community provider agencies

Poverty alleviation work