DAICIA V. JAMES, LMSW

A visitation Social Worker coordinates and facilitates Court Ordered Visitation between children and parents. Visits are conducted in the home or in the community. The Social Worker's role is multifaceted but the primary goal of visitation is assuring safe, comfortable contact between visiting parents and children. The Social Worker maintains authority over visitation and provides counseling and parenting skills training as necessary during visits.

• Integral part of a care management team coordinating social supports for managed long-term care members
• Provides comprehensive Social Work assessment; Engages in advocacy, supportive counseling and education to members of the MLTC, in support of and coordination with R.N Care Managers
• Conducts screenings, assessments and psychosocial evaluations while utilizing critical thinking skills and applicable Managed care criteria to evaluate and identify needs for home and community-based services and/or skilled needs.
• Explained medical care options to help families make informed healthcare decisions.
• Documented case notes daily and coordinated follow-up for seamless case management and organized clinical documentation, treatment plans, and referrals.

• Integral part of a Care Management team to reduce avoidable emergency department and hospital admissions and improve patient care and well-being
• Coordinated specialized care services such as hospice or palliative care when indicated based on individual patient needs and preferences.
• Collaborated with service members to provide effective transition planning.
• Reduced hospital readmissions by identifying high-risk patients and providing targeted interventions.

• Conducted home visits to assess clients'' living environments, identifying potential hazards or unmet needs that might impact their wellbeing.
• Collaborated with multidisciplinary teams to ensure appropriate care coordination and resource allocation for clients.
• Maintained accurate case documentation, ensuring compliance with regulatory standards and facilitating informed decision-making by team members.
• Improved client well-being by conducting comprehensive assessments and developing personalized treatment plans.
• Served as a liaison between clients, families, healthcare providers, and other stakeholders involved in the care process.
• Educated clients about available community resources, empowering them to make informed decisions about their care options.

• Assessed the need for services and develop and update the Individualized Health Plan and Detailed Service Plans
• Coordinated Team Meetings and a constellation of services to meet the specific needs of each enrolled child
• Provided linkages for the child and caregiver to Waiver Service Providers and any additional community services
• Stabilized the environment for the child and caregiver and advocated for the child’s needs to prevent hospitalization or disruption of placement
• Development of a close working relationship with the child’s Case Planner and Mental Health professionals

• Conducted thorough assessments, identifying client strengths and challenges to inform appropriate interventions.
• Maintained accurate documentation, ensuring compliance with agency policies and legal requirements.
• Monitored program effectiveness through data collection and analysis, contributing insights toward continuous improvement efforts within the organization.
• Upheld strict confidentiality standards, ensuring the protection of sensitive client information in all communications and documentation.
• Collaborated with multidisciplinary teams to ensure the delivery of effective services for clients.
• Completed comprehensive assessments of families to identify needs and develop treatment plans.
• Built solid and trusting rapport with children and families, fostering trust and communication to meet case needs.
• Documented data and completed accurate updates to case records.
• Conducted outreach to families and other community partners to identify ways to address social, emotional and behavioral needs.

• Assisted residents in care with school placement and job opportunities
• Completed Supportive Housing Applications for residents aging out
• Ensured that the goals of residents are met and that they have a co-existing relationship with their biological family members
• Developed Psychosocial and Family Assessment and Service plans
• Prepared Permanency Hearing reports and testified at Family Court