Salary Range: $74,854.40 To $89,474.40 Annually

About the Job:

The Nurse Practitioner (NP) provides advanced clinical care, crisis intervention, care coordination and transition support to individuals with complex mental health, addiction, cognitive, behavioural and/or neurological needs. The role supports the ACTT (Assertive Community Treatment Team) Step-Down Program and BSO (Behavioural Supports Ontario) Crisis Response.

The NP supports ACTT clients in transitioning to appropriate ongoing services, including William Osler Health System (WOHS), primary care, psychiatry, community mental health and addiction services, case management and other community supports. Through BSO Crisis Response, the NP provides comprehensive assessment, crisis stabilization, risk management and care coordination for older adults experiencing mental health, cognitive or behavioural crises, working collaboratively with clients, caregivers and community partners to promote safety, continuity of care and successful transitions.

Duties and Responsibilities:

A: ACTT Step-Down Program (0.5 FTE)

- Work independently and collaboratively with the multidisciplinary team to provide assess clients' readiness for transition from ACTT and identify appropriate step-down services and support based on their clinical needs, level of functioning and recovery goals.
- Provide primary/preventive health care as well as clinical assessment, nursing assessment, health screening, metabolic monitoring, medication reconciliation and administration, and prescribe medications within the NP's scope of practice
- Develop and implement individualized transition and discharge plans in collaboration with clients, families/caregivers, the ACTT team and receiving service providers.




- Identify and coordinate appropriate next-step services and programs for clients, including transition to William Osler Health System (WOHS), primary care providers, psychiatrists, community mental health services, case management, and other community-based supports.
- Facilitate transitions to William Osler Hospital and other identified services, ensuring timely communication, clinical information sharing and coordination between SHIP, hospital and community providers.
- Support clients in establishing and maintaining ongoing primary care, psychiatric care and other community supports prior to discharge from ACTT.
- Provide psychoeducation, supportive counselling, health teaching and individualized goal planning to support clients in successfully managing their mental health and physical health needs following transition.
- Identify risk factors and establish, implement and review crisis, safety and relapse prevention plans to support safe transitions and reduce the risk of service disruption or crisis following discharge.
- Establish and maintain solid clinical collaboration with WOHS, primary care providers, psychiatrists, community mental health programs and other external service providers to ensure continuity of care.




- Monitor and follow up on transitions to ensure clients have successfully connected with their identified services and supports and address barriers or gaps in care when they arise.

B: BSO Crisis Response (0.5FTE)

- Conduct comprehensive clinical assessments of older adults experiencing mental health, cognitive, behavioural and/or other complex care crises and/ or responsive behaviors, including assessments in clients’ homes and other community settings.
- Conduct risk, safety and crisis assessments and develop, implement and evaluate individualized crisis, safety and care plans to support stabilization, reduce risk and promote continuity of care.
- Administer and interpret appropriate screening and standardized assessment tools, including MOCA, RUDAS, C-SSRS, PIECES and GDS, as appropriate to inform clinical formulation, care planning and referrals.
- Assess and manage mental and physical health needs within the NP scope of practice, including medication review, reconciliation and prescribing, as clinically indicated.
- Provide clinical intervention, supportive counselling, health teaching and psychoeducation to clients, families and caregivers, and identify factors contributing to crisis, including mental health, cognitive impairment, substance use, physical health, medication-related concerns, environmental factors and caregiver needs.
- Determine appropriate service pathways and referrals and coordinate transitions to mental health, addiction, primary care, geriatric, hospital, crisis, community and other specialized services to support continuity of care and reduce service gaps.
- Liaise and collaborate with health and community partners, including mental health and addiction providers, crisis services, BSO networks, geriatric services, family physicians, hospitals, care c

📌 Nurse Practitioner (Mississauga)
🏢 Services and Housing In the Province
📍 Mississauga