The Hybrid Transition and Community Support Team will assist Class Members in transitioning from nursing facilities to the community and provide support services to Class Members post-transition in the community.

The Peer Support will work with Williams and Colbert Class Members pre and post transition from nursing facilities to support independent living in the community. They will collaborate with the interdisciplinary team to identify strategies to support the Class Member in identifying personal goals and developing increased sense of self determination. They will provide individually based motivational treatment and support to Class Members to assist them in their recovery from mental illness. The Peer Support will be an advocate for Class Members support linkage to needed community services and resources. They will provide client-centered, strengths-based, and trauma-informed services to Class Members with severe mental illness, co-occurring substance abuse/addiction disorders, and physical health concerns utilizing a harm reduction approach.

The Peer Support will provide at least 75% of all community support services in the community They will complete case management tasks with clients within a shared caseload. The Peer Support will also provide crisis/on-call coverage as directed.

The Peer Support must obtain their Certified Recovery Support Specialist (CRSS) credential within 18 months of hire.

Responsibilities

• Assess client’s personal, medical, emotional, social, and environmental situation through home, community, and office visits.
• Coordinate the establishment of an individual recovery plan with the client, client’s support system, and other care providers.
• Model for clients good communication skills, recovery-oriented living skills, effective coping skills, and self-help strategies
• Actively participate in Peer Support meetings and activities to gain additional support in position.
• Identify individual signs of burnout/feeling overwhelmed; and know how to get and provide support.
• Assist in the development of comprehensive service plans, and problem solve strategies to support safe transitions to independent living.
• Facilitate discharge planning with the Class Member, nursing facility employees, and interdisciplinary team members.
• Recognize and act on opportunities to move clients to appropriate levels of care; provide referrals to additional services as indicated.
• Assist clients in identifying signs and symptoms of de-compensation. Work collaboratively with clients to identify coping skills to assist in managing symptoms and stressors experienced.
• Assist clients in learning and improving independent living skills; i.e. personal hygiene, housekeeping skills, nutrition, and shopping for food and personal items
• Educate and assist clients with applying for entitlements; i.e. Supplemental Security Income, Social Security Disability Insurance, Medicare, Medicaid, and LINK
• Accompany clients to important appointments in the community and provide support with issues related to housing, substance use, budgeting, social support, and medication.
• Advocate on client’s behalf and empower clients to advocate on behalf of themselves when appropriate
• Complete daily progress notes based on services provided to clients in a timely manner reflected in organization policies and standards
• Communicate effectively within the team model for a multi-disciplinary approach to client care.
• Actively participate in team communication via multiple electronic platforms
• Provide on-call and crisis coverage as assigned.
• Perform other related duties and/or projects as assigned

Qualifications

• Must have one of the following requirements:
  • Bachelor's degree in counseling and guidance, rehabilitation counseling, social work, education, vocational counseling, psychology, pastoral counseling, family therapy, or related human service field
  • Bachelor's degree in any other field with two years of supervised clinical experience in a mental health setting
  • Licensed Practical Nurse under the Nurse Practice Act [225 ILCS 65]
  • Certificate of Psychiatric Rehabilitation from a DHS-approved program, a high school diploma/GED, and two years’ experience of experience in a mental health setting
  • CRSS certification through IAODAPCA or must obtain CRSS certification within 18 months of hire
  • Family Partnership Professional certificate from and in good standing with IAODAPCA
  • Occupational Therapy Assistant licensed under the Illinois Occupational Therapy Practice Act [225 ILCS 75] with one-year experience in a mental health setting;
  • High school diploma or GED and five years of supervised clinical experience in a mental health setting
• Must be a past or present consumer of mental health services and willing to share their personal story of recovery with our clients
• Valid Illinois driver’s license with daily access to a well-maintained vehicle with $100, 000/$300, 000 liability insurance
• Experience working with people with mental health and/or substance abuse diagnoses preferred
• Experience in community-based services preferred
• IM+CANS certification preferred and may be required to obtain IM+CANS certification within 30 days of hire
• Ability to work weekends as directed