Medical Social Worker

Human Development, Diversity and Behavior in the Environment

Assessment/Diagnosis/Treatment Planning Proficiency Frequency

Knowledge of effects of environment on client system behavior

1

2

3

4

1

2

3

4

Assess family/caregiver dynamics

1

2

3

4

1

2

3

4

Perform Cultural Assessment

1

2

3

4

1

2

3

4

Assess support structure

1

2

3

4

1

2

3

4

Determine Client's eligibility for services

1

2

3

4

1

2

3

4

Engage Client in intake process

1

2

3

4

1

2

3

4

Gather client's biopsychosocial history

1

2

3

4

1

2

3

4

Problem identification

1

2

3

4

1

2

3

4

Assess strengths/challenges

1

2

3

4

1

2

3

4

Perform Risk Assessment

1

2

3

4

1

2

3

4

Assess nature, severity and danger of client's crisis

1

2

3

4

1

2

3

4

Assess for suspected abuse and/or neglect

1

2

3

4

1

2

3

4

Assessment of mental and behavioral disorders

1

2

3

4

1

2

3

4

Assessment of addictive behaviors

1

2

3

4

1

2

3

4

Perform community needs assessment

1

2

3

4

1

2

3

4

Assist client with community resources

1

2

3

4

1

2

3

4

Match Intervention with client system needs

1

2

3

4

1

2

3

4

Clinical Interventions/Case Management

Therapeutic relationship Proficiency Frequency

Obtain/Verify informed consent for treatment

1

2

3

4

1

2

3

4

Engage client in treatment plan

1

2

3

4

1

2

3

4

Intervention process Proficiency Frequency

Develop treatment/service plan for client

1

2

3

4

1

2

3

4

Formulate measurable and realistic treatment
objectives

1

2

3

4

1

2

3

4

Ability to modify treatment plan

1

2

3

4

1

2

3

4

Assist client with grieving process

1

2

3

4

1

2

3

4

Provide conflict resolution

1

2

3

4

1

2

3

4

Patient Rights Advocate

1

2

3

4

1

2

3

4

Coordinate care with pharmaceutical prescriber and provider

1

2

3

4

1

2

3

4

Provide Case Management Services

1

2

3

4

1

2

3

4

Consultation and interdisciplinary collaboration Proficiency Frequency

Facilitate referral process as needed

1

2

3

4

1

2

3

4

Follow up on referrals

1

2

3

4

1

2

3

4

Participate in case conferences

1

2

3

4

1

2

3

4

Conduct court-ordered evaluations

1

2

3

4

1

2

3

4

Conduct custody evaluations

1

2

3

4

1

2

3

4

Professional Ethics/Values

Clinical components Proficiency Frequency

Identification and Resolution of Ethical Dilemmas

1

2

3

4

1

2

3

4

Documentation of Ethical Issues

1

2

3

4

1

2

3

4

Mandatory reporting requirements of Ethical Issues

1

2

3

4

1

2

3

4

Understand legal and ethical issues related to confidentiality

1

2

3

4

1

2

3

4

Protect and augment client self-determination

1

2

3

4

1

2

3

4

Supervision

Ability to: Proficiency Frequency

Understand roles and responsibilities of other healthcare professionals and support staff

1

2

3

4

1

2

3

4

Function in supervisory capacity

1

2

3

4

1

2

3

4

Age Specific Proficiency Frequency

Please indicate the frequency with which you provide care for each age group:

Infant (Birth to 1 year)

1

2

3

4

1

2

3

4

Toddler (1-3 years)

1

2

3

4

1

2

3

4

Pre-school (3-6 years)

1

2

3

4

1

2

3

4

School Age (6-12 years)

1

2

3

4

1

2

3

4

Adolescent (12-18 years)

1

2

3

4

1

2

3

4

Young Adult (18-30 years)

1

2

3

4

1

2

3

4

Mature Adult (30-60 years)

1

2

3

4

1

2

3

4

Elderly (>60 years)

1

2

3

4

1

2

3

4

Years Experience in Clinical Specialty :

Most recent facility worked at:

* I hereby certify that ALL information I have provided to Clover Health Services, on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Proficiency : -	1 = Never Performed	2 = Limited Experience	3 = Comfortable Performing	4 = Proficient
Frequency : -	1 = Never	2 = Sometimes	3 = Often	4 = Always