St. Joseph

St. Joseph
Social Work Services

St. Joseph Regional Health Center(SJRHC) Social Work Service(SWS)'s scope of care is the identification and treatment of patients and their families who have complex psychosocial and/or environmental needs related to the impact of admission, diagnosis, treatment and continuing care needs. SWS staff provide crisis intervention, situational counseling, specialized continuity of care/discharge planning and liaison with agencies in the community. SWS staff work closely with the interdisciplinary team to develop holistic continuing care plans which are appropriate to a patient's psychosocial and medical situation. Referrals for SWS are accepted from physicians, staff, patients/families/friends or community agencies. SWS also screens for continuity of care/discharge planning needs for inpatients who meet certain high risk characteristics. SWS staff is available to provide service to any patient registered at the main Bryan SJRHC facility and at Grimes St. Joseph, at St. Joseph Regional Cancer Center and St. Joseph's Family Medicine Clinics. SWS staff may also be consulted for service by Cancer Center physicians for their private patients at the Center. In addition, SWS staff provides information regarding available community resources to both staff and persons in the community who request assistance. Within the scope of care, the most important aspects of care of SWS are:

Continuity of care/discharge planning for patients with complex care needs

Recognition and attention to psychosocial needs of patients

Staff communication regarding patient needs

Services are provided to patients, their families and significant others to promote maximum benefit from the health care services provided. SWS's primary services are:

To counsel patients and their families in relation to temporary or permanent lifestyle adjustments due to illness and disability

To provide continuity of care/discharge planning for patients with complex continuing care needs

To provide psychosocial evaluation/assessment

To provide information and referral to community agencies.

To provide consultation to staff and physicians regarding community resources and the psychosocial needs of patients.

The SWS office is open from 8:00AM to 5:00PM Monday through Friday. The Licensed SWS staff(six full-time social workers and one full-time nurse) is available between 8:00AM and 4:30PM. The contracted TDHS Medicaid caseworker who is housed with Social Work Service has office hours until 5:00PM. A social worker is on-call on weekends and holidays through the Assistant Director(AD) of Nurses for consultation after regular work hours regarding patient needs. The AD and the on-call social worker discuss the patient's situation to determine whether or not it is a situation that can be addressed during the weekend or holiday, if it may be handled by phone or if it will required the social worker's coming to the hospital to intervene with the patient.

The SWS office is located on the first floor of the main SJRHC facility.

For more information, please contact:

St. Joseph Social Work Services
2801 Franciscan Drive
Bryan, Texas 77802

979-776-3905

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