Services include but are not limited to interventions/referrals to increase access to care, transportation assistance, Advanced Directives, economic assistance, housing assistance for the patients level of need (affordable independent housing, homeless shelters, group and family care homes, Veterans Homes, assisted living, nursing homes, respite care, hospice care) and necessary services to assist with functional decline. In addition to the experience above, candidates must demonstrate all of the following KSAs:(a) Knowledge of community resources, how to make appropriate referrals to community and other governmental agencies for services, and ability to coordinate services.(b) Skill in independently conducting psychosocial assessments and treatment interventions to a wide variety of individuals from various socio-economic, cultural, ethnic, educational and other diversified backgrounds.(c)