Overview Effectively communicates and collaborates with all members of the health care team to facilitate the episode of care so the patient receives services in a safe and timely manner, and the patient and family are provided all necessary resources and education. Interprets and communicates complex patient/family needs and role models caring practices to other caregivers. Assess patients' and families' psychosocial risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, reaction to illness, and ability to cope. Counsels patients and families regarding emotional, social, and financial consequences of illness and/or disability; accesses and mobilizes family/community resources to meet identified needs. Pro