Busting Bureaucracy at DHS
From releasing Peter Boy Kema documents to expanding health insurance for 11,000 children, Lillian Koller is shaking things up at the Department of Human Services
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With daughter Bailey
and I found out that two hospitals had seen one particular child who ended up dying, an infant who had injuries. They had seen the child, called our hotline, but not reported it as an abuse case, but called to inquire if there was a record. But we wouldn’t share that information with them so the doctors made the decision not to report it.”
Koller says she understands where the reticence comes from, since they don’t want to have the whole system come crashing down on the family unnecessarily. They want to be sure before they make a report. But, she says, that’s wrongful thinking, since the department has a forensic physician at its disposal, Victoria Schneider, a forensic pediatrician and founder/director of the Kapiolani Child At Risk Evaluation (CARE) Program.
“I think that it’s a very good thing to be able to collaborate better on cases and to share information, so that across the board children are going to fare better and be safer if information is well-shared,” says Schneider. “I think we do need to respect people’s privacy, but at the same time, and first and foremost, you have to ensure that children are safe. So I think that was a brave move on (Koller’s) part, and I did support that.”
Koller insists that the department needs unfettered reporting so that its professionals can examine and investigate to see if it is indeed abuse and neglect.
“The exceptions we created will allow us to share information with treating physicians, and allow us to share it with genealogy groups who can help us identify family members of the child who could be suitable foster placement.”
Busting bureaucracy isn’t easy, and Koller had a tough fight to get that information released. But she is a lawyer, and through research she discovered that the DHS actually had the power to adopt administrative rules and create exceptions. The law allows it when it’s in the state’s interest or the child’s interest to make an exception to confidentiality. So the DHS had the power all along.
“Lillian Koller brought a lot a new ideas and bold ideas to child welfare services,” says Schneider. “And she’s been very challenged having to respond to the federal review of child welfare services and to develop a real performance improvement plan, which she has undertaken with a gusto and really has made some needed changes within the system.”
Koller doesn’t believe that releasing the information on their abuse and neglect will stigmatize the children, but that it will have the opposite effect: The privacy is actually what places the stigma on the child, making them think they have something to be ashamed of. But, she says, there’s no stigma in being a victim, and it’s not good for the child’s self-esteem to live with that secret.
“There were horrible people in these children’s lives, probably who knew no better because they themselves had gone through this; this is a generational disease,” Koller says. “But it’s certainly nothing that the children should be ashamed of, and if we dealt with it honestly then they would-n’t have to feel stigmatized or shamed. ... I think that this privacy backfires and actually validates, very often, that there is something to keep hidden because there’s some shame associated with it.”
With that frame of mind, Koller attacked other programs that she felt the DHS had shortchanged. For instance, she and her staff developed a simplified Med-QUEST form, called the “pinkie,” which helped enroll an additional 11,000 children and youth in health insurance.
“When I first came here, I turned to my staff, my Medicaid division is called Med-QUEST, and I said, look, the Hawaiian Uninsured Project, Hawaii Covering Kids, they’re all saying there’s about 14,000 Medicaid eligible children not enrolled. What do you think about that?
“According to our staff there were two reasons: The estimate of 14,000 was overestimated and not accurate, based on some research and projections, but it wasn’t reality. No. 2 was they said it’s also because these parents don’t want to apply, they don’t care to go through the process, they’re kind of fringe families that don’t care to access what the state has to offer.”
Koller, the baby of her family who has two older brothers (her mother, Pola, died at age 56 from health problems related to the Holocaust) is a devoted mother herself - she has an 8-year-old daughter, Bailey Pola Jean U’ilani Koller-Schmidt, with former spouse Jeffrey P. Schmidt.
Born in Canada, Koller became a U.S. citizen to vote
for Linda Lingle
“Lillian lives for her daughter Bailey,” says DHS public information officer Derick Dahilig. “She spends her free time taking Bailey out, whether it be to Chuck E. Cheese or trips to Maui.” Koller says it was hard for her to believe that a mother would not care about getting her child free health insurance. So she figured there had to be another reason.
“There has to be some other variable,” she says. “So when I asked Hawaii Covering Kids (a seven-year project launched in June 1999 to create a seamless health insurance enrollment process for children and youth eligible for Med-QUEST) ‘What do you think about the reason why there’s 14,000 kids without health care?’ and they said, ‘Well, your application form is horrendous. It asks a bunch of questions that are scary.’”
The questions included whether or not there was an absentee parent, which many women were afraid to answer fearing retribution from their estranged husbands. The form also stated that a language interpreter would be provided for free, but it was printed only in English, and it listed no fax or phone numbers to contact Medicaid offices.
So Koller and her new staff revised the form, creating a specialty form for pregnant women and children that eliminated those barriers.
Koller also took advantage of federal monies available to the state, a one-time grant of $3 million that could be used for out-reach and IT improvements.
“I took $2 million of that money and entered into a contract with Hawaii Primary Care Association. All of its board members are CEOs of the community health clinics, so we took that $2 million and we ramped up to hire 33 outreach workers.”
These outreach workers were placed in community clinics, and in the Hawaii Healthcare System network, and within less than a year there were 11,000 children getting health insurance. Also, at the suggestion of Beth Giesting, executive director of the Hawaii Primary Care Association, Koller and the DHS got the support of the Legislature to pass a bill to get health coverage for pregnant immigrant women.
Getting the job done does-n’t always require legislation, as Koller proved with the Peter Boy confidentiality disclosures. The DHS also has the power to access federal funds for health programs, and Koller is making full use of that power. In addition to making it easier for the uninsured to gain access to health care, the DHS has also utilized federal funding targeted for self-sufficiency to, well, help folks be more self-sufficient.
For instance, to help able-bodied people in getting off assistance and into the job market, the SEE Hawaii Work (Supporting Employee Empowerment) program provides job placement opportunities for businesses.
Through SEE Hawaii Work, a job placement program modeled after a similar successful plan in Oregon, which operates like a private employment agency, employers can interview clients, and if hired, are reimbursed wages at $6.25 an hour for up to 40 hours a week, and an additional 14 percent in reimbursements for unemployment insurance, Workers Compensation, FICA, etc.
“We have 13,000 people on financial assistance who are able-bodied in the state. And so what we decided to do was create employer subsidy. What we did was entice employers with a free program where we’ll pay for up to a year for this person’s wage.”
SEE Hawaii Work covers the employees’ health insurance, child care, transportation and job skills training.
“We contracted the services from the private sector to run this program. It’s done very quickly; we have a one-page application form to find out from the employer what they are looking for and what the culture there at their work is like, so we try to match it. Within five days we provide them with at least three candidates to interview. They interview them just like they would interview anyone who they would recruit themselves. If they want to hire one of them, great, if they don’t, they don’t. We ask them to put them on their own payroll so that they get paid the same time as everyone else and they’re not stigmatized.”
And DHS provides additional monetary incentives to those workers who stay employed.
These programs are only the tip of the DHS iceberg that Koller and her staff - whom she says she can’t praise enough for the risks they’ve taken - have been busily cracking. She’s built new alliances and encountered a few foes during the past two years, but has moved forward in her mission to provide the neglected, abused and low-income residents of Hawaii the assistance and opportunities they need to become more self-sufficient.
And at press time we learned that “the DHS has secured more than $16 million in federal aid to help public and private hospitals bear the burden of treating uninsured and other needy patients. Gov. Linda Lingle and DHS Director Lillian Koller presented the hospitals with their portion of the federal funds today during a visit to the Healthcare Association of Hawaii.”
Dad would be proud.
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