Social Worker, Complex Care Coordinator - BC Children's Hospital

Social Worker, Complex Care Coordinator

BC Children’s Hospital

Vancouver, BC

The Social Worker, Complex Care Coordinator provides advanced-level clinical psychosocial services to support the management of patients at Children’s and Women’s Hospital (C&W), who live with multiple, rare, and complex medical needs under the care of Ambulatory Care Programs. Complex and rare medical conditions are associated with significant psychosocial complexity and act as barriers to social determinants of health, placing patients at increased risk of experiencing adverse outcomes. Advanced navigation and therapeutic social work skills are required to help patients and families cope over many years. This includes an advanced level of clinical counselling, education and consultation services to patients, families, staff and community centers from across the province to prepare and cope with social, emotional and family impact around decision-making, hospitalization, associated losses, including preparation for transfer of care to multiple adult specialists and subspecialists to manage lifelong and often degenerative conditions.

The Complex Care Coordinator also provides leadership and consultation to satellite programs around the province on psychosocial issues and needs of children, youth and families coping with multiple and complex medical conditions. This includes liaising with centers throughout British Columbia and the Yukon to ensure quality and continuity of psychosocial care for children and their families who travel between centers for therapeutic treatments and medical care. The Complex Care Coordinator provides leadership on best practices through education and research both nationally and internationally.

Working collaboratively as part of an interprofessional team, the Complex Care Coordinator provides information, develops educational materials and resources, and participates in research/evidence-based practice activities and in ongoing quality improvement and risk management initiatives/projects. Services may be provided across a continuum of care in the outpatient clinics, during hospital admissions, outside of clinic times and in scheduled meetings. The Complex Care Coordinator follows the patient and family through all transitions of care including: adjustment to diagnosis, treatment decisions, transition to other hospitals and/or therapeutic centres and transfer to adult care, and in some cases palliative care and end-of-life care. The incumbent works closely with the Social Work Community of Practice to support knowledge exchange, knowledge translation and the development of best practices.

What you’ll do

• Conducts comprehensive individual and family psychosocial assessments. Assesses psychosocial issues in highly complex and acute cases that are beyond the identified initial reason for referral. Provides family and social assessments as needed to assist in decision-making around treatment and care options.
• Manages caseload of inpatient and outpatients, organizing priorities accordingly.
• Screens and makes referrals related to mental health, developmental and educational concerns and recommends consultation with psychology and psychiatry, as appropriate. Liaises with mental health within C&W and community mental health professionals.
• Provides advanced therapeutic psychosocial intervention through individual counselling to children and adolescents. Provides family counselling around adjustment to diagnosis and treatment, grief and loss issues, resources, crisis intervention, conflict resolution and transition to other hospitals or adult care. Assists patient and family with coping strategies to decrease stress in decision-making around treatment, during treatment and transition back to community.
• Provides ongoing crisis counselling and emotional support for patients and families in dealing with frequent hospital visits, unexpected hospitalization, residual effects of treatment such as absences from school due to ongoing medical interventions, and assists with the child’s integration into daycare, school, social and recreational activities.
• Advocates for the patient, family or caregiver for resources within the hospital and the community, which includes co-coordinating and planning complex resources across Canada and the USA.
• Provides leadership, guidance, education and consultation to the team and community regarding child welfare concerns and mental health issues. This includes keeping up to date on changes in child welfare legislation, Freedom of Information, Protection and Privacy, Infants Consent Act, treatment refusal, and educating the interprofessional Ambulatory Care teams on related issues including the C&W Guidelines for children and youth at risk for abuse and neglect.
• Provides leadership to the interdisciplinary team in complex care needs of patients and families including multifaceted discharge planning and determining effective utilization of resources.
• Refers to and liaises with community agencies including schools, First Nations, other hospitals, the Ministry for Children and Family Development, and other charitable funding agencies as required.

What you bring

Qualifications

• Completion of a Master’s degree in Social Work.
• Post-graduate certificate(s) in training model(s) of therapeutic intervention such as advanced family therapy training, individual or play therapy, grief and loss counselling, and advanced mental health interventions.
• Four years of recent, related experience as a social worker providing clinical expertise, as well as comprehensive individual/family/group therapy and teaching related to patients and families facing and living with multiple and complex medical conditions.
• Post-graduate experience or education in clinical research, adult education, and teaching provincially, nationally, and internationally.
• Current full registration with the British Columbia College of Social Workers.

• Demonstrate comprehensive knowledge of the historic and ongoing impacts of settler colonialism and systemic racism on Indigenous Peoples within social and health contexts. This includes understanding how these factors contribute to current health disparities and barriers to care. Show a clear commitment to identifying, challenging, and eradicating Indigenous-specific racism and all forms of discrimination impacting equity-deserving groups within healthcare settings. This involves recognizing personal biases, institutional barriers, engaging in anti-racism education and training and advocating for systemic change.
• Demonstrated knowledge and understanding of legislative obligations and provincial commitments within BCCH contexts found in the foundational documents including Truth & Reconciliation Commission’s Calls to Action (2015), In Plain Sight (2020), BC's Declaration on the Rights of Indigenous Peoples Act (2019), United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), Reclaiming Power and Place Missing and Murdered Indigenous Women & Girls Calls for Justice (2019), the Declaration Act Action Plan and Remembering Keegan: A First Nations Case Study, BC Human Rights Code, Anti-racism Data Act and how they intersect across the health care system.

Core Competencies

• Brings an understanding of the Indigenous specific racism and the broader systemic racism that exists in the colonial health care structure, and has demonstrated leadership in breaking down barriers and ensuring an environment of belonging. Embed Indigenous Cultural Safety and Humility into all aspects of work. This means creating an environment where Indigenous patients feel respected, valued, and understood. Foster trust through respectful communication, active listening, and honoring equity-deserving people's perspectives on health and wellness. Commit to ongoing education and training on Indigenous health issues, cultural safety, and DEI principles. Participate in workshops, cultural immersion experiences, and continuous professional development to stay informed and responsive to equity-deserving groups. Provide patient-centred care that respects Indigenous ways of knowing and healing, respects BIPOC experiences and world views ensuring that care plans are culturally relevant and holistic.
• Knowledge of social, economic, political and historical realities of settler colonialism on Indigenous Peoples and familiarity with addressing Indigenous-specific anti-racism, anti-racism and Indigenous Cultural Safety and foundational documents and legislative commitments (The Declaration Act, the Declaration Action Plan, TRC, IPS, Remembering Keegan, etc.).

Skills & Knowledge

• Comprehensive knowledge of social work theory and practice.
• Comprehensive knowledge of issues related to complex care and the psychosocial impact for children, youth and families.
• Demonstrated ability to conduct and document a comprehensive psychosocial assessment.
• Demonstrated ability to provide individual, family and group counselling, within the context of a health care setting.
• Knowledge of key issues relating to transition of youth to adult care.
• Demonstrated program development skills to identify gaps/needs and plan programs/develop services for patients and their families.
• Ability to conduct group facilitation.

• Demonstrates a commitment to beginning and continuing their personal learning journey related to Indigenous-specific racism and dismantling systems of oppression, as well as addressing racism more broadly. Shows willingness to articulate and share their learning experiences to contribute to a culture of motivation and inspiration among peers.
• Demonstrates foundational knowledge of the social, economic, and political realities of settler-colonialism and its impacts on Indigenous peoples and equity-deserving groups within social and health contexts. Understands the impact of social determinants of health-on-health outcomes. Shows a commitment to learning about and upholding legislative obligations and provincial commitments outlined in foundational documents such as the Truth & Reconciliation Commission’s Calls to Action (2015), In Plain Sight (2020), BC's Declaration on the Rights of Indigenous Peoples Act (2019), United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), Reclaiming Power and Place: Missing and Murdered Indigenous Women & Girls Calls for Justice (2019), the Declaration Act Action Plan, Remembering Keegan: A First Nations Case Study, the BC Human Rights Code, Anti-Racism Data Act, and the Distinctions Based Approach.

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 province-wide programs, services and operations – offering vast opportunities for growth, development, and recognition programs that honour the commitment and contribution of all employees.
• Access to professional development opportunities through our in-house training programs, including +2,000 courses, such as our San’yas Indigenous Cultural Safety Training course, or Core Linx for Leadership roles.
• Enjoy a comprehensive benefits package, including municipal pension plan, and psychological health & safety programs and holistic wellness resources.
• Annual statutory holidays (13) with generous vacation entitlement and accruement.
• PHSA is a remote work friendly employer, welcoming flexible work options to support our people (eligibility may vary, depending on position).
• Access to WorkPerks, a premium discount program offering a wide range of local and national discounts on electronics, entertainment, dining, travel, wellness, apparel, and more.

Job Type: Regular, Full-Time
Wage: $42.27 - $52.81 per hour
Location: 4500 Oak St, Vancouver, BC V6H 3N1
Hours of Work: Monday – Friday; 0830-1630
Requisition # 181160E

What we do

BC Children’s Hospital (BCCH) provides care for the most seriously ill or injured children and youth from across British Columbia.

BCCH is part of the Provincial Health Services Authority (PHSA).

The Provincial Health Services Authority (PHSA) plans, manages and evaluates specialized health services with the BC health authorities to provide equitable and cost-effective health care for people throughout the province. Our values reflect our commitment to excellence and include: Respect people – Be compassionate – Dare to innovate – Cultivate partnerships – Serve with purpose.

Learn more about PHSA and our programs: jobs.phsa.ca/programs-and-services

PHSA and BCCH are committed to equity in our hiring and employment practices. With learning and compassion, we are addressing existing inequities and barriers throughout our systems. PHSA is seeking to create a diverse workforce and to establish an inclusive and culturally safe environment. We invite applications and enquiries from all people, particularly those belonging to the historically, systemically, and/or persistently marginalized groups identified under the B.C. Human Rights Code.

One of PHSA’s North Star priorities is to eradicate Indigenous-specific racism, which includes dismantling barriers to health care employment at every level. We welcome Indigenous individuals to apply and/or contact the Sanya'kula Team (Indigenous Recruitment & Employee Experience) for support at indigenous.employment@phsa.ca.

Indigenous-specific anti-racism initiatives are rooted in addressing the unique forms of discrimination, historical and ongoing injustices, and marginalization faced by Indigenous peoples. These initiatives align with an Indigenous rights-based approach, recognizing the inherent rights and self-determination of Indigenous communities. PHSA must uphold legislative obligations and provincial commitments found in the foundational documents such as including Truth & Reconciliation Commission’s Calls to Action (2015), In Plain Sight (2020), BC's Declaration on the Rights of Indigenous Peoples Act (2019), United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), Reclaiming Power and Place Missing and Murdered Indigenous Women & Girls Calls for Justice (2019), the Declaration Act Action Plan and Remembering Keegan: A First Nations Case Study.

Attention current employees of PHSA:

You must apply via your internal profile at http://internaljobs.phsa.ca.

The internal job posting expires on March 30, 2025 and will no longer be accessible. If the internal job posting has expired, please e-mail internaljobshelpu@phsa.ca with the six-digit job requisition number and your PHSA employee ID number to be considered as a late internal applicant. Please do not apply for the external job posting.

If you have not yet set up an internal profile, please e-mail internaljobshelpu@phsa.ca with your PHSA employee ID number to obtain your temporary password. Our business hours are Monday-Friday 8:30am-4:30pm, excluding Statutory Holidays and a Help Desk Representative will respond to you with 1-2 business days.

If you are not a current employee of PHSA and require assistance with your application, please contact the External Careers team at careers@phsa.ca.