Compassionate Licensed Clinical Social Worker with 20+ years of experience, and a certificate in Pastoral Care and Counseling, I have provided a range of social work services and interventions to adults, older adults and their families in home and community based settings, including the VA Healthcare system. The collective breadth and depth of my experience led me to work in Hospice. In 2017, I took a lead social work role within my organization, in piloting a community based Palliative Care program. Guided by the principles of family systems and meaning making theories, and a strengths based approach to assessment and counseling, I support individuals and families in their quest to make sense of life events in the context of living with serious and chronic illness. As part of an interdisciplinary team, and with use of complementary therapies such as music and journaling, I work to promote improvements in quality of life, restore life balance, and help individuals find purpose in living, even as they may be at or approaching end of life.
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- Active leader in initial and ongoing development of Palliative Care program from pilot program in 2017, to current, fully operational status
- Assist with efforts to market program through educational/informational events to community providers, hosted by Casa de la Luz, and through one on one visits with doctors, nurses, and social workers at various specialist offices
- Conduct educational training sponsored by local country office of aging on topics relating to caregiver needs and advance care planning
- Helped grow program from average 4 to 10 patient caseload, in 2018, to average 50 plus patient caseload in summer of 2019 to present
- Contribute to creation of standard operating procedures, and policies for specialized treatments and interventions, such as Ketamine Assisted Therapy
- Determine program eligibility for patients referred to palliative care services through review of palliative care application, completion of screening tool, review of medical records, and collaboration with team Nurse Practitioner
- Review and coordinate with team assistant regarding patient's insurance eligibility
- Provide appropriate follow up with patient and/or patient representative to discuss self-pay options and/or to complete community service workshop for sliding scale fee
- Work as part of an interdisciplinary team to coordinate and provide a range of professional social work services and interventions that support patients admitted to palliative care, and their families
- Assess psychosocial, spiritual and financial needs of patients and families
- Develop a patient centered plan of care focused on goals of patient and family through a palliative care lens focused on management of symptoms in all domains (physical, psychosocial, and spiritual) and with goal of improving quality of life
- Identify need to utilize complementary services within plan of care, such as music therapy, visiting volunteer, counseling, to augment the holistic are for patients and families
- Counsel and support the emotional needs of patient and family, with option to utilize individual, couples and family counseling modalities
- Help patient and families to identify and initiate discussions of future care needs, and assist with advance care planning to include provision of and education /assistance with completing documents such as Five Wishes
- Participate as a member of the interdisciplinary Agitation Consult Team which provides collaborative input, interventions, and recommendations to hospice field staff who refer patients experiencing behavioral disturbance
- Provide pharmacologic and non-pharmacologic recommendations to hospice field staff to help manage/reduce/eliminate behaviors with goal for promoting patient's peace, comfort, and well-being
- Conduct Ketamine Assisted Therapy with Nurse Practitioner for patients admitted to Palliative and Hospice service, who are assessed to be appropriate candidates, and in compliance with Casa de la Luz protocol, as written
- Design and implement various patient legacy projects that seek to restore meaning and purpose to patients living with serious and chronic illness
- Assessed the psychosocial status of patient/families/caregivers related to the patient's terminal illness and environment
- Conducted patient centered psychosocial assessment to determine needs, and planned interventions based on evaluation findings and with input from patient/families/caregivers
- Counseled patients/families/caregivers as needed in relationship to stress and other identified coping difficulties drawing from clinical knowledge base of themes and crisis that may often arise at end of life
- Collaborated closely with interdisciplinary team members, often on a daily basis, and participated in interdisciplinary team meetings for caseload review
- Conducted comprehensive psychosocial assessment to include patient preferences, awareness/acceptance of diagnosis/prognosis, suicidal ideation, advanced directives, final arrangements, primary caregiver/family, bereavement, for initial and follow up visits, and documented patient centered plan of care
- Assessed Veteran status, and offered education, information, and assisted with enrollment to VA Healthcare, and/or assisted with coordination of veteran's benefits and services, such as Homemaker/Home Health Aide and Respite
- Coordinated Honor Veterans Ceremony for patients, if applicable, as part of Casa de la Luz participation in National We Honor Veterans program
- Facilitated new employee and volunteer training sessions to include Cultural Sensitivity and Competency, Effective Communication, and Integrity and Boundaries
- Presented on the topic of Hospice care as part of an interdisciplinary panel to nursing school students (2018 and 2019)
- Earned certification for social work student supervisory training from Arizona State University, in 2016, and supervised a student for one semester
- Perform all other duties as assigned by Social Work Supervisor
- Coordinated and provided a range of professional social work services and interventions that support veterans assigned to or being assessed for placement in the Home and Community Care Programs of Geriatrics and Extended Care to include but not limited to : Contract Nursing Home, Contract Adult Day Health Care, Homemaker/Home Health Aide and Respite, Veterans Directed Home and Community Based Services Program, Community Residential Care
- Contract Officer Representative (COR Trained March 27, 2013)
- Provided ongoing psychosocial support and assistance to family caregivers enrolled in all Geriatrics and Extended Care Non-Institutional Care programs as named above
- Assisted Veterans and family caregivers in resolution of all Patient Satisfaction matters pertaining to home based services
- Developed policies and procedures for VA home based programs and reassessed and restructured policies and procedures based on changing policies at VA national level
- Developed and maintained effective partnerships with local, state and federal agencies to include Area Agencies on Aging, State Units on Aging, and Administration on Aging
- Caregiver Support team member (2009, 2010, 2011, 2012)
- Provided support and creative input, and assisted in hands on coordination, set-up and implementation of the Caregiver Resource Fair in 2009, 2010, and 2011, under the direction of the Caregiver Support Coordinator
- Led inspections as licensed clinical social worker for assigned nursing home facilities and adult day care centers, community residential and medical foster homes
- Compiled, analyzed and summarized data to assist Program Coordinator in submission of monthly, quarterly and annual reports as mandated by specific programs
- Acting Medical Foster Home Coordinator (April 2010-May 2011)
- Detail assignment as Substance Abuse Treatment Program Social Worker
- Homeless Stand Down Participant Volunteer (Dec 2009 and Dec 2011)
- Performed all other duties as assigned by Social Work Supervisor
2019-Earned Advanced Palliative and Hospice Social Worker Certification as one of three social workers in Arizona to pass the first evidence based social work exam in Hospice and Palliative Care in the inaugural round of testing
2013-Earned Pastoral Care and Counseling Certification-Richmond Hill Retreat Center, Richmond, Virginia
2012-Trained as Veteran's Health Administration Contract Officer's Representative (COR) and achieved score of 100% on final exam
2010-Co-Presenter-National Association of Social Workers Virginia Chapter Annual Conference, Perseverance and Possibility, Williamsburg, Virginia
Member: National Association of Social Workers (NASW)
Member: Social Work Hospice & Palliative Care Network (SWHPN)
Nominee: Arizona Association for Home Care (AAHC) Home Health Heroes, Heart Heroes Award-June 2019
- Casa de la Luz
- Client Stories
- My Legacy Video
References Available Upon Request
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School Attended
- Fordham University
- Bryn Mawr College Social Work Social Research
Job Titles Held:
- Palliative Clinical Social Worker Care Coordinator
- Medical Social Worker
- Community Care Contract Program Social Worker
Degrees
- Bachelor of Arts
- Master of Social Service
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