Earlier last month, a caseworker employed by the state of Arizona was asked to make an unconventional visit to the home of one of her clients with developmental disabilities.
It wasn’t from her usual supervisors at the Department of Economic Security — it was a request from staff within the agency who were investigating the client’s family for possible abuse.
The emailed directive came without much explanation on November 12 from staff in the Quality Management Unit, which includes staff who investigate incidents involving clients who receive services through the agency's Developmental Disabilities Division (DDD) in tandem with Adult Protective Services.
“QMU Triage is requesting a Wellness Visit in a private home with Support Coordination,” the email states. It proceeds to outline the allegations against the familial caretaker under investigation, but does not provide further instruction or detail about the nature of the visit.
The caseworker, who asked to remain anonymous out of fear of retaliation and to protect the identity of the client, had worked at the state’s largest agency for two years. She said she’d never heard of a caseworker being asked to do a “wellness visit” on behalf of investigators before.
“I don’t even know what a ‘wellness visit’ means,” the caseworker said.
The email did not dictate any protocol for how the visit was supposed to take place, or what the caseworker was supposed to be looking for — simply that she was to go to the home with a DDD nurse.
“Even my own supervisor didn’t know what my role was supposed to be,” the caseworker said. “There’s no policy or procedure for what I’m supposed to do when I’m ‘checking up’ on this client.”
Occasionally, caseworkers, also known as support coordinators, witness situations involving clients that require intervention by Adult Protective Services. Typically when this happens, caseworkers play a role in the fact-finding during the investigation — answering questions about a client’s case or providing basic information about a client over email.
“But I was never asked to be a part of going to the house, unannounced, and checking on the client,” she said. “This is the first time I’ve had to get embroiled in an investigation.“
Caseworkers typically make visits to each of their client’s place of residence every 90 days — but these are scheduled and expected. A 2017 DES caseworker job description reviewed by Phoenix New Times makes no mention of "wellness visits" or duties involving check-ins on behalf of investigators or Quality Management staff.
So when the family didn’t answer to door the two times she and the nurse attempted the visit, the caseworker said she felt relieved.
The allegations of abuse against the client by a caretaker were serious, according to the email and to the caseworker herself. The client was allegedly failing to feed her client, who has severe developmental disabilities, more than once a day, and neglecting to bathe and brush the client’s teeth daily. The perpetrator, who is a member of the family, allegedly also did not take the client to scheduled therapy appointments.
“It’s really kind of iffy, because I don’t know if anything I say to that family member or the client is going to cross over into the active investigation, and I don’t know if the family is gonna be hostile,” she said. “I’m not law enforcement, don’t have any self-protective equipment on me, and I don’t have any backup, because I’m only going with another nurse — who’s in the same predicament as me.”
The nurse who is named in the email did not respond to requests for comment.
“A DDD support coordinator may be involved in an APS investigation if they are the reporting source or identified as a witness able to provide information relevant to the investigation,” said Brett Bezio, DES spokesperson, in an emailed statement. He added that Adult Protective Services will work with DDD staff “as appropriate,” and that caseworkers “will continue to work with the member and provide support coordination as they would regardless of an investigation.”
The agency has not responded to requests for comment about this specific incident, or whether “checks” on clients at their places of residence on behalf of the Quality Management Unit is within protocol.
But the caseworker said these kinds of unannounced visits damage her ability to do her job.
“This is my client, and they look to me as being the gatekeeper of their services. It’s not supposed to be an adversarial role,” she said. “But when they put me in this predicament of having to go unannounced to the door like that, and then not even have any instructions as to what I’m doing there, they’re now putting me in an adversarial relationship with my client. The next time I go to see them, they’re going to distrust me.”
The caseworker expressed these concerns in an emailed response on November 15.
“Since it is apparent there is an active APS investigation, I am unsure how this ‘process’ is supposed to work —or — why I’m being directed to engage with the family, with no guidance on how to proceed," she wrote to the Quality Management Unit team.
“This ill-defined ‘procedure’ of going to a family’s residence multiple times (unannounced), with no script, equipment, or prescribed agency instruction places me and other DES employees in potentially unsafe territory,” she went on to say. “What DES/DDD policy/procedure am I following? I am not a peace officer, do not have a search warrant, and am quite vulnerable in having to interface with persons who may be alleged abusers. My showing up at someone’s door like this can be construed as harassment. Additionally, the family that I am expected to serve will now view me as an adversary when I attempt their next review meeting.”
The caseworker requested that the matter be referred to upper management, and stated that the agency and division needed to have a more clearly defined protocol for these situations.
“This situation with the ... family is now interfering with my moral compass and my standard of integrity,” she wrote. “I appreciate whatever clarification you can provide.”
But no clarification has come. Though the caseworker received a reply from a nurse within the Quality Management Unit on November 18, stating that they would direct her concern to leadership, she has yet to receive a written or verbal response.
“There’s been nothing from management,” the caseworker told New Times. “The so-called ‘welfare check’ situation is just a really ill-defined, gray area that I think could lead to some liability issues.
“I debated bringing it up again, but I just don’t really have time to pick this up and do battle again — I have to get this work done.” The caseworker said she currently has 56 clients — 16 more than the maximum she’s supposed to be assigned under state Medicaid policy.
”I don’t know how I would proceed if I got one of these requests again,” she said. “Obviously, our client’s safety is important, but you have to do it in the right way.”