Family Outreach Worker

Job Summary 

Under the direction of the Healthcare Resilience Program Manager, the Family Outreach Worker will work with clients within an OB/GYN clinic to develop care plans, connecting clients to needed services, and following up with clients and providers to assess progress toward client goals. Cultivate a new system delivery paradigm that leads to positive birth outcomes, promotes self-sufficiency, and reduces barriers to care related to social determinants of health.

Qualifications 

• Bachelor’s degree in Human Services or related field is required. 

• Experience or equivalent education/field placement providing social work, care coordination, case management, etc. in human services. 

Supervisory Responsibilities 

This position does not include any supervisory responsibilities. 

Essential Job Functions 

1. Partner with OB/GYN clinic partner to identify eligible pregnant mothers/expecting parents for services

2. Provide telephonic outreach and in-person consultation to identified individuals who would like to join the program. 

3. Assess client needs, based on the Arizona Self-Sufficiency Matrix, or other comparable needs assessment tool. 

4. Based on the Arizona Self Sufficiency Matrix or other relevant assessment results, refer program participants to appropriate resources

5. Identify and consult with supervisor if the client is in crisis and has emergency needs. 

6. Coordinate and monitor services received by the program participants. 

7. Communicate regularly with all providers involved to ensure appropriate care is provided, and to reduce duplication of services. 

8. Attend training on Transition to Success model and implement model with clients

9. Develop individualized care plans with the participants which include client-identified goals that improve outcome and promote client autonomy. 

10. Establish measurable goals with the participant that promote evaluation of the quality outcomes of the care provided. 

11. Establish relationships with assigned clients and their supports and meet with each client as planned, including occasional in-home visits.

12. Establish effective working relationships with service providers and communicate often to ensure the smooth transfer of client information and optimize adherence to care plans. 

13. Document program participant assessments, case notes, and outcomes in the assigned database. 

14. In partnership with Supervisor, provide short-term interventions when appropriate.

15. Make referrals into appropriate social services programs to address maternal and child health and wellbeing, such as Evidence-Based Home Visiting programs

16. Implement health education curriculum where appropriate.

17. Attend Transition to Success, Lactation Consultant, and other required or relevant professional development training.

18. Serve as a point of information and resource for clients, fellow staff members, and service providers. 

19. Perform other duties as assigned. 

Knowledge, Skills & Abilities

• Experience managing and supporting clients' needs. 

• A broad understanding of the local services and the ability to connect clients to these services to meet their needs. 

• Ability to effectively interface with a wide range of partner community agencies. 

• Demonstrated commitment to the field and a passion for serving under-served and under-resourced individuals, families, and/or communities; particularly people living in poverty. 

• Knowledge of maternal and child health, infant mental health, and best parenting practices preferred

• Excellent Communications Skills (oral and written)

• Must be proficient in Microsoft Office programs including Word, Excel, and PowerPoint.

Physical Demands 

While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee frequently is required to use hands to finger, handle, or feel. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision. Work in a non-smoking environment. 

Special Conditions 

Maintain a valid driver’s license and good driving record with appropriate level of insurance.