HealthCaringKW·Kitchener, Ontario
The Social Prescriber supports clients in improving holistic wellbeing by connecting them to community resources and co-creating personalized care plans. The role focuses on reducing social isolation and addressing social determinants of health through interdisciplinary collaboration.
Community Healthcaring KW (the Health Centre) provides a broad range of services aimed at improving the health of individuals and the wider community. Our services include medical and dental care, health promotion, illness prevention and outreach programming. Our expertise and resources are focused on working with those who experience health inequities and barriers to accessing health services. Collaborating as an interdisciplinary team, we provide services and supports that address the social determinants of health including factors and barriers such as poverty, inadequate housing, food insecurity, substance use, language and culture, as well as stigma and social exclusion.
Community Healthcaring KW works with the most complex client population served by primary health care professionals within Waterloo Region. Our highly skilled and diverse team works from a strength-based approach with individual clients as well as the broader community. We collaborate with many partner agencies and organizations within Waterloo Region. Our team consists of Family Physicians, Nurse Practitioners, Registered Nurses, Social Workers, Dietitians, Chiropodists, Pharmacists, Psychiatrists, Health Promoters, Community Health Workers, Administrative Staff, and Volunteers.
We invite you to consider this opportunity to join our team and contribute to this important work.
As part of the Health and Wellness Team at Community Healthcaring Kitchener-Waterloo (CHC) the Social Prescriber will support clients by helping them improve their overall health and holistic wellbeing through personalized community-based care. The Social Prescriber will collaborate with healthcare providers and community resources to assist clients with accessing social and community programs and services, co-creating personalized plans that align with clients’ unique needs. Together, they craft plans that truly matter to the individual. This role provides information, social support, assistance, and problem solving to overcome barriers associated with the social determinants of health, with a focus on social isolation.
1. To provide information, assistance, and support to help clients access community resources. 2. Connects individuals or families with community programs, organizations and informal supports. 3. Focuses mainly on supporting social isolation, stress, or lifestyle-related concerns. 4. Focuses on improving health through social connection and community engagement. 5. Establish and maintain knowledge of internal and external community resources, programs, and services. 6. In collaboration with Primary Care and Health and Wellness the Social Prescriber Community will create, maintain and evaluate an effective internal referral pathway. 7. Connects, liaises, and establishes partnerships with local health care professionals and networks within the community. 8. Actively listen to and provide resources to clients who face barriers to services; older adults, refugees, families experiencing poverty, those who are unsheltered and people with mental health and addictions. 9. Provides information regarding appropriate community resources to support the holistic wellbeing of the participant and their families. 10. Engages and participates in learning opportunities such as in community of practices, planning tables or networking events. 11. Prioritize referrals to meet individual client’s needs. 12. Collaborate with the primary care providers by gaining their support to interpret and prioritize physical/medical and/or holistic well-being of clients. 13. Completes intake process to assess strengths, needs, abilities, and risks using motivational interviewing techniques such as active listening, conflict resolution and observing behavior. 14. Prescribing by using EMR (electronic medical records), performing follow up calls, entering data and program promotion within the CHC. 15. Maintain accurate health records and up to date notes in the Electronic Medical Record in a timely manner and adheres to all CHCKW policies and Privacy legislation. 16. Documents participant’s interactions, wellness plans, reports, and other administrative duties as required. 17. Provision of follow-up note to continuing community health care provider if requested. 18. Participate in health promotion and quality improvement initiatives, research, data collection and evaluation as needed. 19. To assist the Health and Wellness team with the coordination and facilitation &/or co facilitation of various in person and community-based programs that focus on life-skill development, capacity building, volunteerism, and social networking. 20. Participate in team and staff meetings and other meetings and committee work as appropriate to support both service delivery and organizational goals. 21. Work from a Social Determinants of Health perspective to improve health outcomes for individual clients and/or for the development of community health and well-being, and to reduce health inequities. 22. Work in a manner that ensures confidentiality, client safety and minimizes risk to clients, volunteers, and the Centre. 23. Work in a manner consistent with the Health Centre’s Vision, Mission, and Values. 24. Work in a manner consistent with the Health Centre’s policy and commitment to Diversity, Equity and Inclusion in all processes and practices. 25. Work in a manner that demonstrates self-reflection and personal accountability. 26. Adhere to appropriate infection control practices. 27. Perform any other duties as assigned by your supervisor.
Accountability: This position reports to: Manager, Health Promotion and Community Services
1. Post-secondary school education in social services, social work, mental health, community development, or equivalent. 2. Understanding of health promotion, education, community development and social prescriber. 3. Extensive knowledge of relevant community resources, services and networks within Kitchener-Waterloo. 4. Experience providing one to one client support and community resource sharing. 5. Excellent interpersonal skills and the ability to communicate effectively with clients. 6. Excellent collaborative skills and proven ability to establish and maintain effective working relationships with all internal and external contacts. 7. Experience working effectively with culturally and economically diverse populations, those who experience barriers to healthcare and who are socially isolated. 8. Training and/or specific experience with non-violent crisis intervention and de-escalation techniques an asset. 9. Good organization and time management skills. 10. Demonstrated ability to communicate effectively in English, both written and verbally. Second language is an asset. 11. Competency in the use of a Microsoft Office Suite. 12. Ability to maintain strict confidentiality. 13. Maintain a valid driver’s license, access to a reliable personal vehicle and adequate insurance for work-related travel in accordance with Community Healthcaring KW 14. Ability to obtain a Police Vulnerable Sector Check satisfactory to the Health Centre. 15. 2-Factor Authentication for Outlook is App based (Microsoft Authenticator Application) and used to ensure the security of our online accounts. 2-FA requires the use of a personal mobile device with a recent operating system.
Application Deadline: July 28th, 2026
Requires post-secondary education in social services, social work, or a related field, along with extensive knowledge of Kitchener-Waterloo community resources. Candidates must possess a valid driver's license, a reliable vehicle, and the ability to pass a Police Vulnerable Sector Check.
Market context
In Ontario, behavioral-health roles are typically driven by ongoing need in community, outpatient, and support settings serving people with mental health or substance use challenges. These positions can be competitive because employers often look for experience with diverse populations plus a high school diploma or GED, with a bachelor’s in social work or a related field preferred. Review the AI-summarized requirements and benefits here to save time, then tailor your application to show relevant client-facing experience and readiness to work with varied needs.
