Summary

Duffy Health Center is a patient-centered medical home, and every role requires functioning effectively using a team-based approach. The Community Health Worker (CHW) is responsible for examining, analyzing, and evaluating facts and circumstances surrounding individual problems, situations, transactions and determining actions to be taken within the limits of standard or accepted practices for patient care and scope of practice. This position is deemed non-essential* in the DHC Emergency Operations Plan.

Position Functions

The statements contained in this job description reflect general details, as necessary, to describe the principal functions of this job, the level of knowledge and skill typically required, and the scope of responsibility. It should not be considered an all-inclusive listing of work requirements. Individuals may perform other duties, as assigned, including work in other functional areas to cover absences or provide relief, to equalize peak work periods or otherwise to balance the workload.

Conducts outreach, case finding and education services, to identify and target individuals who are homeless or at risk of homelessness and in need of health care and other services.

2. Provides support for strategies to facilitate referrals, transitions, and communication among and between systems of care on behalf of persons.

3. Visits with patients/clients to develop relationships, provide peer support, and promote harm reduction and self-care behaviors.

4. Screens for patient needs and assists patients/clients with access to health care and other services.

5. Assists patients/clients with navigating through systems of health care and community social services, helping overcome barriers presented by adverse Social Determinants of Health (SDOH), such as using public transportation and escort to appointments as needed.

6. Assists clients with maintaining linkages with care providers and partner agencies, promoting adherence to medical regimens, plans of care, and achievement of self-management goals.

7. Promotes access to self-help groups, treatment programs, and other services in the community.

8. Completes CHW reports as required by funding sources. Reports may include daily encounter logs, grant data monthly submissions and summaries of interventions for medical documentation.

9. Participates in all relevant meetings, conferences, and committees as assigned or requested.

10. Assists Duffy Health Center program staff in educating hospital and community partners about unique needs and issues related to homelessness and access to health care.

11. Maintains a positive working relationship with coworkers, hospital staff, and community partners.

12. Maintains professional ethics, adheres to Duffy’s philosophy of care, complies with grant activities and program expectations, and abides Duffy Health Center’s Employee code of Conduct.

13. Maintains awareness and cultivates knowledge of comprehensive resources within the community on behalf of and in response to the health and human service needs of patients/clients.

14. Maintains a case load of patients/clients as required by the funding source, provide ongoing follow up to patients/clients for adherence with care plans, appointments, and progress towards goals.

Recommended Minimum Qualifications

Minimum Education and Experience

An applicant for this position requires a minimum of a High School Diploma or educational equivalent with one (1) to three (3) years of lived experience with homelessness, mental health, physical health and/or addiction issues.

Requirements under the DHC Emergency Operations Plan

During a declared Emergency, staff deemed as Essential Personnel are expected to work onsite at Duffy Health Center and Non-Essential Personnel are expected to work remotely. This position is non-essential and therefore this position may be expected to work remotely’ during a declared emergency.

Knowledge, Skills, and Abilities

A candidate for this position should have the following:

Knowledge of or willingness to learn:

Local groups and organizations providing social services
Microsoft Office programs, including but not limited to, Excel, Word, PowerPoint, etc, Issues related to homelessness and at-risk individuals, including mental illness, substance abuse, criminal history, and physical and sexual abuse.
Protocols for handling crises and maintaining confidentiality.

Skill in:

Motivational interviewing
Peer expertise gained through life experiences
Assessing and addressing the needs of persons who are homeless or at risk of becoming homeless
Effective outreach to patients/clients who are struggling with physical and/or mental health issues, substance use issues, and/or homelessness or risk factors for homelessness

Ability to:

Share personal story and hope for better health with patients/clients
Navigate public transportation system and educate patients/clients in using public transportation
Operate small office equipment, including a PC, scanner, and copier
Interact effectively and appropriately with patients/clients and community contacts
Maintain confidentiality of information
Commit to the philosophy and mission of Duffy Health Center, which serves people experiencing homelessness or at risk of homelessness, and to the team-based approach as part of PCMH

Accountability

The nature of work means that errors can be easily detected, usually by the employee. Consequences of errors, missed deadlines or poor judgment may result in minor confusion, involving minimal time and expense for correction.

Judgment

Well defined or detailed rules, instructions and procedures cover all aspects of work. Judgment involves choosing the appropriate practices, procedures, regulations, or guidelines to apply in each case.

Complexity

The work consists of simple, routine, or repetitive tasks and/or operations with few variations in established procedures.

Supervision Required

Under direct supervision, where clear, detailed, and specific instructions govern the work or are explained with each assignment. The employee works as instructed and consults with the supervisor as needed on all matters not specifically covered in the guidelines or instructions. The supervisor maintains control by reviewing the work in progress or upon completion.

Nature and Purpose of Contacts

Relationships with co-workers and the general patient population involving frequent explanation, discussion or interpretation of practices, procedures, regulations, or guidelines in order to render service, plan, or coordinate work efforts, or resolve operating problems. Other regular contacts are with patient/service recipients and employees of outside organizations such as healthcare or social service agencies. More than ordinary courtesy, tact and diplomacy may be required to resolve complaints or deal with hostile, uncooperative, or uninformed persons.

Work Environment

Employee work involves everyday discomforts typical of offices, with occasional exposure to outside elements. Noise or physical surroundings may be distracting but conditions are generally not unpleasant.

Physical Demands

Little or no physical demands are required to perform the work. Work effort principally involves sitting to perform work tasks, with intermittent periods of stooping, walking, and standing. There may also be some occasional lifting of objects (up to 10 lbs.).

Motor Skills

Duties are largely mental rather than physical, but the job may occasionally require minimal motor skills for activities such as moving objects, computer and/or most other office equipment, typing, filing, sorting, or operating a motor vehicle.

Occupational Risk

Duties of job present little potential for injury. Risk exposure may be similar to that found in typical office settings.

Confidentiality

Has access to confidential information obtained during performance of regular position responsibilities, where the effect of any disclosure would probably be negligible or where the full significance of the overall confidential matter would not be apparent in the work performed.

Essential*

Employees designated as “essential,” a standard Incident Command term used in Emergency Management, typically work on-site to

provide direct clinical care or management of such.

Non-essential*

Employees designated as “non-essential,” a standard Incident Command term used in Emergency Management, typically work off-site

remotely to provide either clinical or administrative support to clinical operations.

Duffy Health Center Inc

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