Community Transition Team Systems Navigator

7 months ago

Coquitlam, Canada PHSA Full time

**Community Transition Team Systems Navigator, Community Transition Team (CTT)**
BC Mental Health & Substance Use Services

Coquitlam, BC

Correctional Health Services (CHS) is a province-wide, specialized program providing care for clients who are incarcerated in one of BC’s 10 provincial correctional facilities. We believe everyone deserves a chance to access healthcare treatments and heal, and CHS offers a non-judgemental place to help make that happen. Check out what it means to be apart of the CHS team **HERE**. Please indicated in your cover letter why you are interested in joining our team at the Community Transition Team

**What you’ll do**
- Work from a culturally informed, client-centered, client-choice based care model to coordinate referrals to care, especially primary care and social supports. Work with Indigenous partners and with the FNHA in partnership and the best interests of the clients and families. Where clients have complex or unique needs, facilitate holistic care planning, proactively engage with and coordinate inputs from a range of different service providers, influence health and community care providers and leverage existing service providers to bridge health and social offerings, support of the community and to ultimately support the best outcomes for clients. Referrals may support access to counselling services, income assistance, housing, legal support, food, education, immigration support, employment training, disability assistance, clinical case management, mental health and addictions services.
- Participate in care coordination meetings and multidisciplinary case conferences as needed to support client access to care. Network with service providers and build collaborative relationships to support care planning.
- Work alongside community members, community service providers and health service professionals to engage in community capacity building efforts with a focus on supporting and expanding local service options and to support service enhancements.
- Provide brief supportive counselling and information services to clients. Establish trust, confidentiality, credibility with community members, review referral information and case histories, interview service providers, referral agents and other sources, determine risk factors for threats of harm to self and others, mental health issues and substance misuse. Maintain knowledge of various care pathways, service options and care providers across the province to facilitate accurate information provision and referrals.
- and emerging practices related to this patient population.
- Maintain records in accordance with established procedures and policies, and prepare/maintain statistical data, correspondence reports and other documentation, as required. Provide an ongoing commitment to client services and continuous improvement to ensure enhanced client services and that services are provided in most effective way.
- Participate on internal and external committees relevant to program services as directed by the Program Manager or Regional Director.

**What you bring**

**Qualifications**
- Master’s degree in social work or Behavioural Science from a recognized program.
- Minimum one (1) year of recent related clinical experience working with complex care individuals with significant mental health, substance use issues and/or cognitive limitations; must include experience in trauma informed, culturally sensitive and gender affirming service delivery.

**Skills and Knowledge**
- Demonstrated systems thinking skills attained either from university level systems course(s) and/or experience.
- Knowledge of and commitment to strengths-based, client-centred practice.
- Knowledge of community development, community health agencies and services.
- Knowledge of the range of service options available for the designated client population.
- Knowledge of solutions and strategies to reduce various barriers to care for the designated client population.
- Knowledge of facilitation, mediation, and conflict resolution techniques.
- Awareness of and commitment to learning and understanding the Truth & Reconciliation Commission’s 94 Calls to Action (2015), In Plain Sight Report (2020), BC's Declaration on the Rights of Indigenous Peoples Act (2019), and other related reports.
- Commitment to upholding the shared responsibility of creating lasting and meaningful reconciliation in Canada as per TRC (2015) and BC's Declaration on the Rights of Indigenous Peoples Act (2019).

**What we bring**

Every PHSA employee enables the best possible patient care for our patients and their families. Whether you are providing direct care, conducting research, or making it possible for others to do their work, you impact the lives of British Columbians today and in the future. That’s why we’re focused on your care too - offering health, wellness, development programs to support you - at work and at home.
- Join one of BC’s largest employers with prov

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