Health and HUman Services System The Connection

May 7, 2012

Lorena Alicia Solis: Technology’s Nice, but Passion, Caring Still
Define APS Workers’ Careers

Day in the life For some American workers — bank auditors, online college teachers and cable TV troubleshooters, to name just a few — online and wireless technologies make it possible to serve customers they’ll never meet face to face.

At DFPS, the exact opposite is true. The agency’s adult and child protective services divisions are using remote communications and computing devices to jailbreak investigators from their offices and give them more time to do what they signed on for: protecting vulnerable people from abuse, exploitation and neglect.

While on her stationary-bike ride last week, Alexander got to see CNN’s coverage of the shuttle Enterprise leaving Dulles in Washington for its final home in New York City. (The reason the TV picture is blurry in our photograph is due to the scanning frequency of the monitor.)

Lorena Alicia Solis, an APS investigator in El Paso, does most of her “office” work wirelessly from her car using a compact computer, scanner and printer. Solis’ work is made easier by this steering–wheel-mounted computer tray crafted by her husband.

Adult Protective Services investigator Lorena Alicia Solis of El Paso is one of about 20 such workers in her city. Although she admits to a bit of nostalgia for her old desk in the central office, she recognizes how working almost constantly “in the field” extends her effectiveness and helps her respond faster in critical situations.

In this account of a representative day on the job, Solis talks both of the changes technology has brought to APS and of what never changes: the critical importance of personal commitment, passion and empathy for the agency’s clients.

“Many people don’t really know what this job is about or what it is we do,” Solis said. “It’s my pleasure to share my experience and maybe create a little more understanding.”

• • •

image of clock 8–9 a.m.: Solis begins the typical office worker’s routine of checking overnight emails regarding cases, then making and receiving follow-up phone calls, emails and text messages.

I have a lot of devices with me at all times, including a cell phone for state business, a personal phone, and a printer and scanner. I don’t need the printer and scanner for every case, but the phones are essential, so they’re always there.

Every day, first thing in the morning, I turn on my computer so I can email my router [a colleague responsible for assigning cases] and my supervisor and confirm that I’ll be out in the field. That can be a little hard some days because we work with wireless cards, and the technology [laughs] isn’t always100 percent in every area. Then I start receiving case-related phone calls — often from the office, or from clients or collaterals [people with knowledge of the cases, such as doctors or home health aides] — and I try to write down as much documentation as I can. Sometimes I use sticky notes and sometimes my tablet [computer], which is a little bit smaller than a notebook PC.

When we take action like that, we’re sometimes regarded as intruders, but the truth is, we save lives.

You always want to pull over before you start typing or writing, of course, and I’ve done it pretty much everywhere you could imagine: in parking lots, under a tree, in a park, outside my house — just anywhere you can. If it’s a pretty day, I sometimes like to step out of my car, put my computer on my hood and do the work there. I know of a co-worker who parked out on the street somewhere to have a conversation with a client. He’d stayed there about 20 minutes before the police passed by, decided he looked suspicious and almost busted him! I guess we draw extra attention because we have all these computers and electronic tools in our vehicles.

image of clock  9–11 a.m.: Solis plans her day out based on the wildly unpredictable range of challenges she faces involving multigenerational clients facing countless issues and threats.

There are so many possible situations based on all the different individuals we serve. Just to give you a few examples: We deal with individuals 18 and older with some kind of disability and with people 65 and older, whether they have a disability or not. Then, within those groups, we work with those who have all kinds of mental illness, as well as disabilities that could be anything from mental impairment to vision impairment to a temporary physical impairment such as recovery from a knee surgery, where you’d just need extra help for a short period of time.

We also deal with individuals who are hoarding in their homes, individuals who don’t have their utilities on, family feuds about things like whether the house should be sold, financial exploitation cases, and individuals who can’t afford food or medications.

Then there’s another situation that can be very complicated: people with mild mental impairment who have some support at home. These individuals often feel that they understand pretty well what’s going on in their lives, and that they should be allowed more independence, but that mom and dad or other caregivers are trying to control everything they do. In reality, the caregivers usually are just trying to help. That’s pretty common. I see this not only with younger people but older individuals as well.

You’ve got to have passion for the work and compassion for individuals. Without that, you won’t last very long.

When you have these different groups of people who mean well but disagree, I talk first with the individuals we’re serving and try to recommend what I think they need. Often it’s a provider to help with bathing, cleaning or meal preparation. If it’s an older person I’ll often tell them, “There comes a time in life where we have to admit we need help. We’ve helped others for so long, but now it’s time to allow ourselves to be helped because that can enable us to stay in our homes.”

A lot of times they agree, but sometimes they don’t. In those cases, we have to assess the individual’s mental capacity and determine whether they have the capacity to make that decision. If they do, we can’t force the services on them. We just give them community referrals and say, “If you change your mind, this is who you can call.”

11 o'clock 11 a.m.-Noon: Based on the severity of the need for help, Solis applies different strategies and approaches.

We’re required to do a monthly visit with most individuals, but some cases that require two or three visits a week. I dealt with one situation like that where a lady’s husband had recently died and she was left alone. Our job was to make sure she was OK and that nobody was taking advantage of her while she was grieving and vulnerable. One of the ways we did that was to bring in a guardian to help her take care of her financial responsibilities and some of her other benefits and personal business decisions.

In those cases, you also keep an eye out for possible financial exploitation. So I took special note when I heard that she’d sold a computer for $40. People who are vulnerable like she was often have a lot of people around them who say they’re “friends,” and you have to be alert that your client is not being taken advantage of.

In situations where I’m sure exploitation is taking place, or when the person is in immediate danger, I immediately speak with my supervisor. Then we get our subject-matter expert involved and let her know what’s going on. We talk over every aspect of the case, and if we all agree that we need to act right way, we get our legal counsel involved — along with anyone else whose expertise might be needed.

2 o'clock 1–3 p.m.: Solis uses her instincts, knowledge and contacts to help clients who have been identified as highest-priority cases.

When you really care about people, you see it reflected on your work, your cases and everything else you do.

One of the highest priorities might be one of medical neglect. But before you act, you have to look closely to make sure that’s really what’s happening. You look at an individual’s mental capacity and try to determine whether they fully understand what’ll happen to them if they don’t follow up on a doctor’s appointment or don’t take their medications appropriately. If they choose not to, they have that right.

However, in clear medical neglect cases, you need to intervene immediately. For example, I had one case where a man had gangrene in his legs. You could see these dark pinkish and reddish colors in his skin, and the odor was terrible. But he was in denial; he thought the pink color meant he was healing. I called my supervisor, then our attorney and got the courts involved to get the necessary order for him to be examined. He wouldn’t have sought medical care on his own, but it saved his life.

When we take action like that, we’re sometimes regarded as intruders, but the truth is, we save lives. We have to put our two cents’ worth in, even if people don’t always like it. But at the same time, we have to understand that we’re dealing with human beings, and we’re here to serve, above all.

4 o'clock 3–5 p.m.: In addition to serving their clients directly, Solis and her colleagues also spend considerable time documenting their work and helping orient new workers and other professionals in the world of adult protective services.

We’re required to have 24-hour documentation of what we do with our individuals, so I carry my tablet at all times. I’ll even use it during interviews if it’s appropriate and the situation is safe enough to allow me to take my attention away from the client and the surroundings for a few moments.

If the weather’s OK, I often work on my case documentation in my car. One of the great tools was actually made for me by my husband. It’s a flat piece of wood that clips to my steering wheel and allows me to have my tablet right above my lap without holding it. My colleagues are always telling me he could make a lot of money by selling those tablet holders to them as well!

Another big part of the part of the job is orienting others to adult protective services. For example, we have interns from a local university who shadow us as we do our work. We also train new APS workers and take student doctors out on scheduled “dates,” to give them a better understand how APS works with [the medical and health care community].

And then there’s always trainings, meetings, services planning and all sorts of other things. It’s not a 40-hour week — ever!

General Thoughts on the Job: My degree is in social work, and that’s what I’m in it for. When I talk to young people about this job, the first thing I always say is you’ve got to have passion for the work and compassion for individuals. Without that, you won’t last very long. I’ve been here for seven years and I still have passion. If you lack the passion, you’ll be out in six months.

We have workers who come in here and have trouble with various aspects of the training, but I can still see their passion and caring. You try to keep people like that because you know they have the main asset to succeed.

When I see those folks, I tell the supervisor: “She’s got it; let’s work with her and develop her.” And after a few months or years, we usually find ourselves thinking, “Yep, we were right.” When you really care about people, you see it reflected on your work, your cases and everything else you do.

Is there a job or person in health and human services you’re interested in learning more about? E-mail us at hhs.communications@hhsc.state.tx.us and tell us about it. It may be our next “Day in the Life” feature.

Investigators: Key Players in Protective Services

At DFPS, employees with a vast range of skills and responsibilities help protect older adults, people with disabilities and children from abuse, neglect and exploitation.

When the agency receives tips or reports about any of these issues, Adult Protective Services or Child Protective Services investigators quickly respond by contacting all potentially involved parties, including the alleged victims. These investigators (565 for APS and 1,735 for CPS during FY 2011) do their work in many settings, including family homes, state hospitals and supported living centers, community MHMR centers, and private intermediate care facilities, among others.

Based on their findings, they support their agency colleagues in follow-up processes such as obtaining in-home support providers, referring reports to other state agencies and making referrals to courts or law enforcement. They also maintain ongoing relationships with clients in the system, as well as their families, neighbors, legal guardians and other interested parties.

It’s a role that requires a sensitive, balanced approach that honors the client’s right to maximum independence while also fulfilling a duty to protect their life, health and assets.