Outreach Social Worker

Who We Are:
Since 1985, BHCHP’s mission has been to ensure unconditionally equitable and dignified access to the highest quality health care for all individuals and families experiencing homelessness in greater Boston. Over 10,000 homeless individuals are cared for by Boston Health Care for the Homeless Program each year. We are committed to ensuring that every one of these individuals has access to comprehensive health care, from preventative dental care to cancer treatment. Our clinicians, case managers, and behavioral health professionals work in more than 30 locations to serve some of our community’s most vulnerable—and most resilient—citizens.

From our earliest days as a program, we have always sought to do work that is transformational: recognizing our shared humanity; centering dignity, compassion, mutual respect and supporting the right of every individual to access the highest levels of health care and every staff member to reach their fullest potential. We continue to be committed to building bridges and breaking down barriers, including systemic racism which harms us all. We provide community-based health care services that are compassionate, dignified, and culturally appropriate, incorporating social determinants of health, with the goal of breaking down the physical and systemic barriers that our patients face.

Bilingual, Bicultural, LGBTQIA identifying, Black, Indigenous, and People of Color are encouraged to apply.

To learn more about working at BHCHP, watch our video Please Click Here.

Job Summary:
***NOW OFFERING A $4,000 SIGN ON BONUS***
Hours:   Full time, Monday – Friday, 8:30am -5:00pm
Union: No 
Name: Non-Union
Patient Facing: Yes

In the context of a vibrant multidisciplinary HIV Primary Care Team at Boston Healthcare for the Homeless Program (BHCHP), we are looking to hire an Outreach Social Worker to provide harm reduction-oriented, community - based linkage and retention services and behavioral health supports to a subset of vulnerable homeless patients living with HIV/AIDS. Patients are referred to this specialized program if they are newly diagnosed with HIV, they are disengaged from care, or they are unable to manage adherence to HIV medications and do not have a fully suppressed HIV virus level. Using strength-based approaches, you will engage with patients to address self-identified barriers to care which may include active substance use disorder, behavioral health issues, chronic homelessness, and legal issues. This multidisciplinary intervention aims to support patients in building the skills to more effectively navigate care systems to sustain effective engagement in care and improve HIV health outcomes.  This position is funded until the end of June 2026 with the possibility for renewal.  If this funding is not renewed, this position will end June 30, 2026.

Responsibilities: 
Provide intensive linkage and retention outreach services to approximately 10 of the HIV team’s most vulnerable patients living with HIV and experiencing homelessness, with a focus on building therapeutic relationships to promote medication adherence and active engagement in health care.
Linkage and retention services specifically will include:

• Accompaniment to medical, social service, housing and legal appointments and debriefing with patients after visits and updating HIV team and collaborating agencies as needed.
• Field-based outreach and other activities to locate patients who may be out of care, or at high risk of disengaging from care. Outreach may be conducted with other team members including HIV nurses, and medical case managers, and other outreach behavioral health staff including psychiatric providers and social workers. Outreach sites will include streets, shelters, patient homes, AIDS service organizations, hospitals, residential treatment programs, and other locales as needed.
• Co-create Individual Service Plans (ISP) with clients as well as with input of the multidisciplinary HIV team, monitor implementation of ISP and document updates in electronic medical record. Provide crisis intervention counseling and ensure linkage to emergency psychiatric services when necessary.
• Assist with care coordination during discharge planning for patients in an inpatient setting at local hospitals.
• Provide advocacy for patients involved in the criminal legal system, assist patients in reconnecting to care in the post-release period and provide motivational interviewing and harm reduction counseling for patients with substance use disorders, as well as for those engaging in other high-risk behaviors.
• Work with the HIV team to identify potential candidates for linkage and retention intervention; as well as to identify patients who are ready to transition from the ARCH program to traditional medical case management.
• Participate in weekly multidisciplinary Patient Care Meetings and monthly HIV Team meetings as well as attend Team Huddles as appropriate. Attend weekly BHCHP Behavioral Health Team Meetings
• Document all client interventions/activities and referrals in electronic medical record. Complete all reporting duties as required by grant agencies, and other reports as requested. Maintain professional ethics, boundaries and client confidentiality.

• Massachusetts LICSW and LMHC preferred, LCSW required or license eligible.  Must be licensed or must obtain license within 18 months (for LCSW) or 42 months (for LMHC) of hire date.
• Knowledge of harm reduction frameworks, trauma informed care principles, and motivational interviewing required.
• Experience working with people with active substance use disorder required.
• Experience and demonstrated interest in working with people living with HIV, people experiencing homelessness and people impacted by incarceration and the criminal legal system is preferred.
• Experience with referrals to dual diagnosis and other recovery treatment programs, and other social service providers a plus.
• Effective verbal, written and interpersonal skills with the ability to interact with providers and team members from various settings. Knowledge of community and health resources, particularly addiction-related resources and supports a plus.
• Demonstrated commitment to equitable and culturally appropriate care for a wide range of diverse populations, including (but not limited to) communities of color, LGBTQIA+ communities, non-English speaking populations, immigrants, people with histories of incarceration, people with substance use disorders, and people experiencing homelessness.
• Ability to work in a fast-paced environment, with excellent communication skills, critical thinking, and problem-solving abilities. Ability to work with patients with dual or multiple disorders, including complex trauma who also have chronic medical illnesses.
• Ability to be flexible, take direction and work independently, cooperatively, and accountably as a member of a multidisciplinary treatment team.

• Strong computer skills with proficiency in Microsoft Word, Outlook, Excel, and other database systems. Strong organizational, time management skills, interpersonal and communication skills.
• Experience with electronic health records is desired. Comfort working in outreach settings (street, shelters, etc.).
• Bilingual English-Spanish preferred.

• The compensation starts at $60,000.00 and will increase with years of experience; additional compensation for LICSW and LMHC.
• BHCHP full time employees are eligible for our competitive time off policy of 4 weeks’ vacation, health, dental and vision insurance, 403B retirement savings plan and employer retirement contribution, and pre-tax MBTA pass program with 40% discount. In addition, eligible employees will receive yearly increases, additional annual compensation of seven thousand five hundred for demonstrated bilingual proficiency and the opportunity to work with local hospitals and community health centers.

Does this amazing opportunity interest you? Then we'd love to hear from you.

As an Equal Opportunity Employer, BHCHP pledges not to discriminate against and encourages those from underrepresented and underserved backgrounds to apply, particularly Black, Indigenous, and People of Color (BIPOC), LGBTQIA identifying, first generation college students and adults without a college degree, Bilingual and Bicultural persons; and individuals from low economic backgrounds.

Covid-19 Vaccination: Proof of Covid-19 vaccination(s) is optional for employment. Candidates who are offered employment will be given details about how to demonstrate receipt of vaccination if they choose to.

Please Note: Employment at Boston Health Care for the Homeless is at-will. Boston Health Care for the Homeless does not sponsor work authorization visas.