Inpatient Discharge Social Worker

Job summary

The Transition Social Worker role requires excellent interpersonal and leadership skills to support both the Acute Mental Health Service Line and the broader community. The primary focus is to reduce readmissions by ensuring a smooth transition from admission to discharge and providing ongoing support to high-risk patients in the community.

The purpose of a Transition Social Worker in Adult Social Care is to complete assessments, including those mandated by the Care Act 2014, and to enhance the well-being of eligible individuals. In addition to adhering to the practice standards set by Social Work England (SWE), Transition Social Workers must apply a wide range of knowledge and skills to build relationships and work directly with individuals, their families, and carers in a strengths-based way, empowering them to achieve the best outcomes.

The role involves working proactively to identify patients at high risk of readmission and developing tailored discharge plans to address their specific needs. The Transition Social Worker will collaborate closely with both Acute Mental Health Units and community teams to overcome barriers to discharge, ensuring patients receive the necessary support to thrive outside the hospital.

Main duties of the job

oTo work within the regulation of the Care Act 2014 and other relevant statutory frameworks.

oTo apply Social Work principles and values to professional practice and to emulate our corporate values in all interactions with patients, colleagues, and partners.

oTo effectively manage a reasonable caseload appropriate to the level of experience and to maintain adequate throughput of work. To discuss any challenges with caseload management with your line manager in a timely way to access any necessary support with prioritisation.

oTo provide support and expert advice on social care to social assessors, students, and partners.

oTo be professionally curious when undertaking effective assessments of individual and carer needs and risks within statutory frameworks, using a strengths-based, person-centred approach to ensure they are focused on outcomes. This includes promoting a holistic, multi-agency approach by developing and maintaining collaborative working relationships.

Job description

Job responsibilities

The Candidate Pack provides an overview of the key tasks and responsibilities of the role, and the person specification outlines the qualifications, skills, experience and knowledge required. Please view as attached

The person specification below is not the full person specification, but outlines the criteria against which your application form will be assessed.

Person Specification

Qualifications and Training

Essential
oCurrent professional registration in relevant clinical subject/practice e.g. Social Work,
oEvidence of post qualification training/education.
oOngoing evidence of continuing professional development.
oA commitment to completing full quality
oImprovement development as outlined in the trust strategy

Desirable
oTraining in providing supervision, mentorship or equivalent, or willingness to undertake training.
oPost Graduate degree (in relevant subject).
oTo have completed or be working towards accredited courses which enable potential development
oRecognised training that supports clinical practice (Psychosocial Intervention or DBT)

Experience

Essential
oDemonstrable experience of working at Band 5 or equivalent for 2 years.
oExperience of liaising with community agencies.
oExperience of working with people who have experienced serious ongoing mental health problems.
oExperience of working within a multidisciplinary team.
oExperience of conducting effective assessments including of risk.
oExperience of developing care and support plans that deliver personalised, integrated care and support that helps people to maintain their independence and attain the outcomes they want
oExperience of working collaboratively with patients, their families and other professionals
oExperience of making effective decisions that make best use of available resources to meet eligible needs and achieve outcomes.
oExperience of implementing the principles and practice of the Recovery approach

Desirable
oExperience of implementing changes in working practices
oExperience of using and supervising others in the use of psychosocial interventions
oExperience of using quality improvement methodologies
oExperience of implementing and monitoring standards of care, including clinical audit and governance

Knowledge

Essential
oSound knowledge and skills in risk assessment
oKnowledge of safeguarding policies and procedures
oClear understanding of the Mental Health Act, Care Act, Housing Act, Quality & Safety Governance, Clinical audit and relevant national policies
oKnowledge of recent initiatives across professional workforce
oClear understanding of the process of Supervision

Desirable
oAbility to contribute to, monitor and implement changes and improvements to services
oFamiliarity with budget control and management
oAbility to monitor and control resources
oKnowledge of performance management procedures
oAbility to think creatively about opportunities for practice development
oAppreciation of the ward/team manager's role and how to balance clinical and non-clinical responsibilities
oKnowledge of Recovery Model of care
oAbility to work within a Team

Skills

Essential
oAbility to maintain Social Work Professional Standards
oAbility to model and encourage our Corporate values and behaviours and to be positive, open-minded, supportive and respectful to colleagues, partners and residents
oAbility to communicate effectively with others and ability to write a clear, accurate, consistent and timely and case record and reports as per the Recording Guidance
oThe ability to effectively manage time effectively, including adequate throughput of casework, learning and other team requirements
oThe ability to effectively use supervision to support caseload management, raise risks and ask advice, reflect on practice and contribute towards development of core skills and competence
oTo be technically proficient and able to use IT equipment, able to demonstrate digital solutions for residents and carers and understand pertinent data

Desirable
oSpecialised clinical skills, e.g. group work, anxiety/anger management, CBT, family work skills

Other Requirements

Essential
oAbility to reflect, identify and take responsibility for continuing professional development needs
oUnderstand the need for and actively participates in own supervision and constructive use of feedback
oHigh levels of initiative, innovation and self-motivation.
oCommitment to client-centred, non-discriminatory practice.

Desirable

oAble to demonstrate a strong professional identity.