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Sunday, March 9, 2014
Lillian Koller Department of Human Services Director
By Terri Hefner
The status quo didnt stand a chance. Appointed by Gov. Linda Lingle in 2003, Lillian B. Koller, convictions firmly in place, took control as director of the state Department of Human Services.
There was no time to waste. The most vulnerable in our state were being neglected and abused, and not enough was being done about it. So Koller rolled up her sleeves and jumped right in, reviewing, reorganizing and restructuring the department.
Her tenacity has earned her a bit of a reputation, and she admittedly has annoyed some people. Amid organized clutter in her busy Miller Street office, Koller displays a stuffed bear wearing boxing gloves a gift from her staff a Tazmanian Devil T-shirt and another tee embellished with a crown and the slogan Royal Pain.
When we came to this job, with this administration, Ive just been working at a frantic pace to get the types of changes that I believe made some very significant improvements in peoples lives, the most vulnerable people in our state, says Koller, who received her undergraduate degree in philosophy at the University of California, Los Angeles, and then went on to earn a law degree from the Martin Luther King Jr. School of Law at the University of California, Davis. She came to her current position from serving as the Drug Court Program coordinator for the Second Circuit Court in Hawaii, planning, developing, implementing and managing the Maui Drug Court Program.
The DHS umbrella covers the Benefits, Employment and Support Services Division, Med-QUEST Division; Social Services Division; Vocational Rehabilitation and Services for the Blind Division and Office for Youth Services.
I can give you specific examples that Im very, very pleased to have had the governors support to achieve, and the hard work of our staff to support us in 180 degree turnarounds in the practices and policies and procedures of the department, says Koller. Quite a number of those turnarounds have occurred in the past two and a half years.
Go ahead. Try to get a word in edgewise. Koller, 50, born in Toronto and a longtime Maui resident I became an American citizen at 43 so I could vote for Linda Lingle, she says gives detailed, rapid-fire responses to questions and packs an incredible amount of information into each sentence. Her conviction and drive are intense.
So where did that fierce determination to champion the rights of the underserved come from? Well, unlike George W. Bushs heavenly muse, Kollers inspiration comes from her earthly father, David Majer Koller.
Hes a Holocaust survivor. He just passed away July 12 in October he would have been 93. And he was definitely my inspiration; hes why I have the acute sense of needing to correct any type of injustice, and type of disparity of peoples condition, any type of racism, sexism, because he taught me from the time I was 4 years old about mans capacity for cruelty, says Koller.
But he was always extremely life-affirming with the horrors that we cannot even imagine that he witnessed. He lost everybody near and dear to him (in a Nazi death camp); he was the only survivor in his family at all. He could have come out that experience a very negative, very destructive, angry man. But he was full of hope; he was teaching me the lessons to be extremely cautious and attuned to the types of things that people say and do that indicate a prejudice or racism, or the conditions that people find themselves in that dont give them a fair chance to have the benefits that we have, and to help them achieve the most they can in their life and not let things stand in the way; help them bust through barriers and help them be resilient.
There is a huge sense of obligation that he gave me to fight for justice and to represent the disadvantaged and advocate for their needs to be met.
Is it any wonder that Koller has embraced her job and proceeded full steam ahead to improve the department? And as those whove been on the business end of her convictions have learned, shes all business when it comes to her mission and meeting her goals.
Youve likely read and/or heard about her major policy-changing act as director of DHS releasing the information on Peter Boy Kema, the little Big Island boy who went missing eight years ago and still has not been found.
It didnt get us anywhere to have that secrecy for eight years, and you dont get the lessons learned, explains Koller. You must get the examination of people from the outside to see if theres a need to change our system and the way it works to prevent this from happening again, and to get justice for this child, and to get closure for those who grieve.
I understand the confidentiality rules are well-intended, but they need reasonable exceptions so it doesnt backfire on us. In fact, those rules that we amended we created a set of exceptions to confidentiality for child welfare those go well beyond the Peter Boy Kema case. It allows us to share information.
Koller says that being unable to share information on DHS clients had a far-reaching effect on not only law enforcement, but the doctors as well.
When I got here I felt the dysfunctional impact of the confidentiality rules. I was literally two weeks coming into this job 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 wouldnt 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 dont 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, thats 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 its 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 peoples 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 (Kollers) 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 isnt 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 its in the states interest or the childs 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 shes 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 doesnt 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, theres no stigma in being a victim, and its not good for the childs self-esteem to live with that secret.
There were horrible people in these childrens lives, probably who knew no better because they themselves had gone through this; this is a generational disease, Koller says. But its certainly nothing that the children should be ashamed of, and if we dealt with it honestly then they wouldnt 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 theres 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, theyre all saying theres 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 wasnt reality. No. 2 was they said its also because these parents dont want to apply, they dont care to go through the process, theyre kind of fringe families that dont 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 Uilani Koller-Schmidt, with former spouse Jeffrey P. Schmidt.
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 theres 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 outreach 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 doesnt 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 well pay for up to a year for this persons 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. Its 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 dont, they dont. We ask them to put them on their own payroll so that they get paid the same time as everyone else and theyre 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 cant praise enough for the risks theyve taken have been busily cracking. Shes 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.
Posted: September 29, 2005 @ 9:05 AM HST
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