Government's Role in Human Services
Price of Paradise · Hawaii Public Radio · aired 1995-09-24
Guests: Guest host: Tom Mitrano; Susan Chandler (Director, Hawaii Department of Human Services); Frank Chong (Director, Waikiki Health Center)
Duration: 1:08:48

[00:00:00] Tom Mitrano: Good morning. This is the Price of Paradise radio show. I am Tom Mitrano. I'm sitting in for Randy Roth, who's off today. Randy believes that in a healthy community, there is lively and informed public discussion, and I agree with him. That's why I'm happy to sit in. The Price of Paradise show is sponsored by the Hawaii Community Foundation. The mission of the Foundation is to carry out flexible, visionary, and inclusive grant making and to foster an expanding pool of permanent charitable funds from diverse donors. Today we will address the topic, should our state government be responsible for health and human services or not? We're talking about basic human needs today. Food, shelter, clothing, health, and employment.

[00:00:52] Tom Mitrano: With me in the studio to discuss today's topic are Dr. Susan Chandler and the Reverend Frank Chong. Dr. Chandler is a member of Governor Cayetano's cabinet. She is director of Hawaii's Department of Human Services. Now she is not the director of the Department of Health, which is a separate state agency, but we might get into some of those subjects too. Dr. Chandler earned her PhD in social welfare. She has worked as a social worker in the fields of youth services, mental health, community health planning, and as a crisis worker for the sex abuse treatment center. Before joining state government early this year, Dr. Chandler was on the University of Hawaii faculty for almost 20 years. Good morning, Susan.

[00:01:38] Susan Chandler: Good morning.

[00:01:40] Tom Mitrano: Reverend Frank Chong is the executive director of the Waikiki Health Center, a position he has held for almost 20 years. He holds master's degrees in both divinity and in social work. Reverend Chong has taught from time to time in the UH School of Social Work, too. He is a well-known legislative lobbyist and author of the Yellow Pages lobbyist handbook, which I've used quite a book, quite a bit. Thank you for coming today, Frank.

[00:02:07] Frank Chong: Good morning and thank you.

[00:02:09] Tom Mitrano: Many of you were expecting Randy Roth. He'll be back next week. Today, though, I'll try to fill his shoes. I'm Tom Mitrano, head of community affairs at Bank of Hawaii. Over the last four years or so, I have served as a volunteer management consultant to hundreds of nonprofits, government agencies, and private sector businesses who are dealing with constant change and shrinking resources, particularly in the areas of health and human services. I'm here today to take your calls and engage our guests in lively conversation. Let's begin. Susan, let's start with you. In today's Honolulu Advertiser, you mention how Governor Cayetano is pushing you very hard to increase efficiency in your agency. He wants you to streamline and reengineer your governmental processes.

[00:03:01] Tom Mitrano: I and many others think you can prove to him that you are doing this. But some people are asking if there isn't some hidden plan to dismantle the delivery of human services by the state of Hawaii. Recently, there was a list published of all the programs that have been cut and some people have said it's a devastating list. In the long term, what is your administration's vision for human services, say, through the next 10 years? Will your department exist in the future?

[00:03:32] Susan Chandler: Well, I certainly hope my department will exist uh in the future. I think that uh there is an extremely important job to be done to um make human services more efficient and more effective. And um I guess I disagree slightly with the uh the two gentlemen here this morning because I do not believe, as was written in the paper, that uh what has happened in the public sector is a dead end or that all welfare services are failing or that the public sector really is unable to provide high quality um human services. I think the public sector uh can get more efficient, and I think the governor is is uh working very hard with all of his cabinet heads to find places where we can do things more efficiently and more effectively.

[00:04:17] Susan Chandler: But generally, I believe, as I think the governor does as well, that there is an a an essential role for the government in both the provision, the design, and the evaluation of um human services. I think we've had many um experiences where services not provided by the public sector do not provide services equitably. They may provide them at less cost, but they may not be providing to all the people who need the service, they may not be providing them with uh within the laws that we want to see happen, and uh provide these services in in a high-quality way. So I believe that there is a crucial role for the Department of Human Services in this state and in every state.

[00:04:59] Susan Chandler: And what I worry about in terms of the national government is that when you devolve this responsibility to the community, however that's defined, or even to the states, you lose some of that um bottom-line protection. I think that um services like uh sex abuse services um are not the things that uh the private sector has readily leapt into in terms of providing. It was the public sector who said that these services should be provided. Money was gotten from the legislature to put these services together. Now, while the private sector in partnership can provide these services very well, it has to be in partnership. And I think that the role of the public sector is essential in a in providing um high quality services and being a player in defining which services will be going to the community and uh and how they'll be provided.

[00:05:49] Tom Mitrano: I think you've introduced a lot of studies. We're going to have fun with today. Thanks. But I want to turn to Frank right now. Frank, maybe my number's not accurate to the penny, but the entire state spent about $80 million last year to purchase health and human services from your agency and in a lot of others in Hawaii. Susan's department alone, Department of Human Services, spent about $16 million. Now, this doesn't even count department budgets, United Way funding, foundation grants, fees for services, federal funding, a lot of other sources of funding you have. But lots of people, social work professionals, as well as ordinary citizens say, if these uh that things are getting arguably worse.

[00:06:34] Tom Mitrano: For the third to the half of our fellow citizens at the bottom of the human services scale, things are not getting better. If these professionals uh ask you and the other agencies why the state should continue paying you to provide services if you aren't making people better, what do you say?

[00:06:56] Frank Chong: Well, the obvious answer is uh the there's not enough money. Uh, 80 million out of an annual annual budget of about 6 bil 6 billion is really minuscule. Uh probably a more important question is, what is the uh uh what is the appropriate role for the private sector? And how do you measure whether we make a difference or not? And what is the larger context? I think the the question has to be asked in the context of how complicated are the problems that we're dealing with. I think we can say real clearly that we're making major headways in certain areas. In other areas, obviously it's such a disaster that um the amount of money that we are working with, say 80 million, is really a drop in the bucket.

[00:07:43] Frank Chong: Uh take for example areas like uh we're very much involved with child abuse, um early interventions for a lot of uh health and human service issues. Susan mentioned sex abuse treatment programs and others. The uh the private sector in many ways has been the early warning system, has been trying to prompt other groups to take on a larger role. I think the conflict that we're or the the collision course we're on right now is uh with the uh with resources dropping so rapidly. How do we arrive at a a a common consensus as to the role of government and the role of private sector? And how do we get this partnership that we're talking about um become a reality?

[00:08:29] Frank Chong: Because obviously, the 80 million is not really, relatively speaking, in terms of the total state budget or the total amount of money going into human services, uh is really not uh not that significant.

[00:08:41] Tom Mitrano: Uh, Susan, Frank said there's not enough money. Are you fighting to get more money for him and the other agencies that provide basic services?

[00:08:48] Susan Chandler: Well, I think that um I would turn that question around a bit. I think that uh the state doesn't have enough money to do the kinds of services and programs that it would like to do. Um as we all know, budget and finance director Earl Anzai has been saying over and over again that if you don't have the money, it's impossible to spend it. If uh the state would like to um amend the Constitution, if the people would like to amend the Constitution and get us out of the requirement for a balanced budget, then presumably there could be more money. I think we must fight for um sufficient dollars in health and human services programs, and I do I do that.

[00:09:25] Susan Chandler: And I think this governor particularly has been very clear that education and human services are indeed his um his number one and two priority. Um but that doesn't really get us necessarily to the point of are we spending these dollars well, both in the public sector and in the private sector? I think we're never going to have enough money so that all of us think, gee, this is the right amount of money and we're all spending it well. So I think um just going back and saying we need more money to the legislature is not a is not convincing anymore. I think we all need to be able to better demonstrate what we're doing with the dollars and prioritize the dollars so that we are um providing the most essential services.

[00:10:08] Tom Mitrano: How does uh how how does one arrive at priorities? The the the question that uh I would pose is, what what are the criteria that one uses in arriving at any prioritization system? Because I agree with Susan, it's not an issue only of money. Uh if if there are no standards and if there are no particular uh plans, then then the political uh how well you work the political system or how well you understand lobbying, becomes the way in which you get money allocated to your particular program. And so without the commitment to uh a very comprehensive plan and a sophisticated enough criteria system so that it uh begins to measure, uh I know, and in other areas, we talk about outcomes.

[00:10:59] Tom Mitrano: I think some of the outcomes that we can be clear about is that uh I know personally that we've got more healthy people that we work with than uh we had in the past. Uh, we've we've made a difference in some people's lives. But our organization is really relatively small. I don't know what it's like in terms of the entire community. Now Susan, when when Frank starts talking about prioritization, to a lot of observers, it seems that the way the state prioritizes is simply economics. Fact, in the focus section of this morning's advertiser on the page opposite our articles is a clever cartoon, uh where the president of the university is talking to the students and say, it looks like you all failed economics.

[00:11:40] Tom Mitrano: This is a question of dollars. Well certainly the Department of Human Services, it can appear to observers to be that you're prioritizing by just seeing how far the money goes and then you stop. In government, is there a vision for how our community is healthy, and what status it's in, through the use of human services, or is it simply economics 101?

[00:12:04] Susan Chandler: No, I don't think it's economics 101. I think that um clearly we have to be conscious about what the dollars are that we have to spend. That's how the political process works. Um I agree with both of you that um perhaps a more uh clear dialogue with the community, with private sector agencies, um to discuss what our priorities are in the in in human services is a very good idea. I know with the Department of Human Services, we published a list for our private agencies to say what we felt the um prioritized uh guidelines would be when we took our cuts. We talked about the fact that we are mandated to provide almost 80% of our services, and unless the laws change, we don't have a whole lot of flexibility with those.

[00:12:51] Susan Chandler: We then wanted to ensure that the clients that were most at risk were the ones who indeed would be served. We wanted to ensure that um we were providing services where the private sector does not provide services. We don't want to be in competition with the private sector. We also wanted to make sure that the services were in the appropriate places because we don't have a whole lot of competition to provide um emergency shelter services on Molokai. So um we do have a listing of criteria. We have shared it with um our private sector agencies that we contract with. But I think you're right. I think we do need to do that um perhaps earlier and more often and try to get some consensus about uh what it is that the state wants to provide and sees as a sees as its priorities.

[00:13:36] Susan Chandler: It's interesting to me, and I didn't know this before I took this job, that we have already about 80 different advisory groups from the community that come in and tell us what we should be doing. We're not doing it on our own. We also are required to discuss everything that we do both publicly and at the legislature. So it really isn't that we're a fortress. Um we have advisory groups over child welfare, we have technical advisory groups over Medicaid, we have a advisory councils over our jobs program made up of employers. People are constantly telling us what they think we should be doing and how much better we should be doing it, but that doesn't mean we still can't be better in our communication.

[00:14:14] Susan Chandler: I like the notions of outcomes. I we are trying also to move so that we have a better idea of the progress we're making and in what units we need to make it faster. So I don't disagree with any of that. I think maybe we disagree about how quickly we're implementing some of these things, but I look forward to that kind of dialogue.

[00:14:31] Tom Mitrano: In case you joined us late, you're listening to pop radio, the Price of Paradise. I'm Tom Mitrano, sitting in for Randy Roth. Our topic today is the role of state government in providing health and human services. My guests are Dr. Susan Chandler, director of the state Department of Human Services, and Reverend Frank Chong, executive director of the Waikiki Health Center. To ask a question or make a brief comment, just call 955-8821. Neighbor Islander, uh Neighbor Islanders, please, you're invited to call collect. That number again is 955-8821. And David is standing by on his cellular. David, good morning. If you've got a comment or a brief question to ask someone?

[00:15:15] Speaker 1: Yes, thank you for Dr. Chandler regarding efficiency in government. Um, do you I I I learned that uh state workers receive 21 days of sick leave the moment they sign on as a state worker. Do you know how many days of sick leave that you members of your department take on average?

[00:15:32] Susan Chandler: No, I'm sorry, I don't. I understand that uh sick leave is a negotiated benefit in the um public workers contracts. Uh we monitor sick leave um and presumably they take what they're um what the contract provides them to take.

[00:15:49] Speaker 1: Well, I understand that you can accumulate those days, 21 days per year for two years, and then after that you may lose those days of sick leave. My question to you is, uh do the people in the department take their full 21 days of sick leave, whether they're sick or not in that third year? Wouldn't that be a good thing for a department head to know?

[00:16:08] Susan Chandler: I think it would be a good thing for our um for a department head to know. Um I know that there has there's in the press, there's been some concern about other departments where there's been an abuse of sick leave and um you know, I know that all of us are are um looking into this. In my department, I tend to be um mostly uh talking to people who are not only not taking sick leave, but they're mostly concerned about the fact that they're working overtime because they are trying to provide services um that don't happen necessarily between 7:45 and 4:30. So I'm not sure that this is a particularly difficult problem in the Department of Human Services, but certainly a department head should know a lot about it.

[00:16:47] Tom Mitrano: As a department head, did you receive a letter from Representative Gene Ward asking you to list how many people work for you in your department and how much you paid for them, paid them?

[00:16:54] Susan Chandler: Yes, I did.

[00:16:55] Tom Mitrano: Did you respond to it?

[00:16:56] Susan Chandler: Yes, I did.

[00:16:57] Tom Mitrano: How many was it?

[00:16:59] Susan Chandler: Um we have about 2,100 uh full-time employees, then we have part-time employees and we have um persons who are on contract. Um I don't have my numbers on employees with me, but we certainly know those numbers and I can make them available to you when you like if you want to leave your name with the um the the radio station here.

[00:17:25] Tom Mitrano: Oh yes, they would. Yeah, I asked Representative Ward. I think he sent letters to other 19 department heads. Is that how many there are?

[00:17:30] Susan Chandler: Yes.

[00:17:31] Tom Mitrano: David, David, uh you're as you are uh raising these issues, you seem to be hitting on this efficiency issue. Is it your perception that the Department of Human Services simply is inefficient and should be changed or deleted?

[00:17:44] Speaker 1: Well, I I I simply I can't simply don't know. I know one way we could determine that as we could look at, uh is there an abuse of sick leave, uh do people take exactly 21 days of sick leave when they when it appears they're going to lose that? Is there any requirement to say, uh that I was sick, or is it an errand day? Are the days of sick taken on Fridays and Mondays? Those the things that department heads should know, uh and a Dr. Chandler should just clearly know those things if she was interested in efficiency of her department. And I I challenge her to learn those things.

[00:18:14] Tom Mitrano: I appreciate that. And certainly that it hits right into the topic we're talking about today is, Department of Human Services, should it continue or not. Thank you very much, David. Appreciate it.

[00:18:24] Frank Chong: Let me respond to that. Let me say a little bit about the private sector. In the private sector, we have a different problem. We have a limited amount of money to carry us for 12 months, and so we can't afford to carry a liability into the next fiscal period. Having said that, we've struggled with the issue of vacation sick leaves and so forth. And some of the more innovative approaches, which we happen to be using at the Waikiki Health Center, is that we give every individual 24 days of paid leave. When lose or draw, you take it whatever way you want, whether you're sick, hungover, your daughter's uh may day.

[00:19:00] Speaker 2: program or you are on vacation. So, uh, what we have found is the largest sick leave, or so-called sick leave has dropped dramatically and people save up their time for vacations. So within that 12 months, you've got 24 days, you take it whichever way you want. You begin the next year, it was zero. So we don't carry into the next year, uh any liabilities. Of course, there are exceptions, you can carry into the next year about five days of of leave or something like that. But but it's a it's a different issue and it looks at different areas of efficiency.

[00:19:32] Speaker 3: Thank you, we've also now got Bobby from holding. Bobby, good morning, if you've got a brief comment or a question you'd like to ask of our guests?

[00:19:38] Speaker 4: Thank you, I have a brief comment.

[00:19:40] Speaker 3: Please.

[00:19:41] Speaker 4: Uh more people are coming here to live. There is higher unemployment, therefore there are less taxes being paid, therefore there is much more help needed. We started paying attention to child abuse, etc., etc. Therefore, I'm not on either side of this question. Uh what are we expected to do, support all of them, tell people not to come, give more jobs, etc. I'll let you people take over. Thank you very much.

[00:20:18] Speaker 3: Thank you, Bobby. Well, Frank, that's a actually opens an excellent question. Uh people are confused about the delivery of health and human services. Certainly, the appeals of private sector agencies never end. It's it's not one distinguished citizen dinner, it's a hooli hooli chicken. How are we to make sense, we citizens to make sense of the delivery of human services when it is such a confusing system that doesn't seem to deliver results?

[00:20:48] Frank Chong: Well, first of all, I disagree with the fact that we don't deliver results. I think we do, but the the more basic question of how do we, uh how do we fund it, how do we work with it, what does it all mean? Uh, the delivery of health and human services is very obviously a very complicated issue and as more people come to come to Paradise, the price of providing that goes up. I think we're in a real struggle right now deciding whether or not the private, so-called private sector picks up the cost or the public sector picks up the cost. Both the areas have always bear borne part of the burden. I think what we're seeing is that it's getting much more complicated and the complication comes in because people are getting older.

[00:21:33] Frank Chong: We have a lot more, we're paying a lot more attention to the needs of older people. Growing up obviously in this community or any community today is extremely complicated. And so part of it is, what is our public policy with regard to health and human services? For example, we have a public policy that says education will be a responsibility of government. That is public education is a major commitment that we will always provide. In the area of health and human services, it's not so clear. In some areas of human services very definitely, we have entitlement programs, we say we're committed to taking care of certain areas. In health, it's kind of depends on the time of day and who you talk to.

[00:22:17] Frank Chong: Medicare, Medicaid, sometimes, it gets less and less clear. I think the the issue has to do with how developing a comprehensive policy, or at least a plan that says these are things which we have to have in our community.

[00:22:33] Speaker 3: Well, do you perceive a lack of policy or direction on behalf of the state?

[00:22:36] Frank Chong: Very definitely. For example, when we make budget cuts, it it appears that we make budget cuts based on on a budget-driven system as opposed to a program-driven system where we say we're committed to this. Like in education, for example, we have to cut the budget on education, so we say, okay, you lop off here and there, but we don't say, well, this year we'll eliminate the third grade because we can't afford it. We don't say well we'll eliminate third and fifth grade. We say we'll provide all 12 years, but there may be some other things outside of that basic core that we may be able to to take out and so that becomes a whole new new issue.

[00:23:15] Speaker 3: Susan, what what is your response to the the challenge to the policy, the existence of a policy at state government? Does it appear appears to lots of people that there really isn't some guiding principle out there, it's simply economics.

[00:23:29] Susan Chandler: Well, um, I guess I find that a little surprising because, um, I spend, uh almost every day from January to May listening at the legislature to all kinds of people talking about what sorts of services should be provided. It is a democratic system. It may not necessarily end up with the priorities that everybody likes, but that is the time when um policy is being uh established. Um the Health and Human Services Committees talk daily for the 60 day legislature about what they believe should be the priorities of the state. What um they are elected representatives and they go into their community and they listen to uh what the community says and then they put together a budget.

[00:24:12] Susan Chandler: Now certainly the Governor has opportunities to reshape that budget and when the um legislature doesn't provide a budget that uh you know, is balanced, then the the Governor must take some restrictions. But um I guess I'm not quite agreeing with the notion that it's um there's no policy or there's no clear priorities. I think within Health and Human Services, this state particularly is extraordinarily committed to the provision of high-quality health care and health care for the poor. I think this state has an extraordinarily um strong commitment to the provision of high-quality child welfare services. I think um this state does not seem to be as committed to emergency service programs like uh general assistance or some of the um programs that are cash assistance programs that are given to um some disabled people.

[00:25:03] Susan Chandler: That the legislature is willing to cut the dollars away from and uh there won't be those services anymore. So I think that there are um there are various ways that policy is being expressed rather clearly. And I think that it is exactly our responsibility to um to ensure that that continues by going to the legislature and making these kinds of um clear discussions about what indeed are the community's priorities. Because without that, you you are left with the departments saying, well, all right, how about these priorities? Do you think these are all right? And then who are we communicating with? Do we ask the Aloha United Way? Do we ask Tom Metrano? Do we ask the actual providers of service?

[00:25:45] Susan Chandler: Who who is the community that will be helping us shape these priorities?

[00:25:50] Speaker 3: I think that I think that's a very very good issue because the mechanisms to gather public opinion and to help shape policies today is getting much more complicated. In many ways, it's he who speaks the loudest and lasts the longest is the one that gets their policy pushed through. I need to say though, I'm I'm very disappointed with the legislature. I think that uh for most purposes our legislature today has withdrawn from the debate. I I think that Susan's right in that we spend 60 days every spring talking about priorities, but by and large, health and human services in the legislative pecking order is not very important. Basically, you you always end up with money and laws and the whole issue of health and human services becomes uh of lesser importance.

[00:26:42] Speaker 3: There needs to be a different forum and I don't know exactly what the shape of that forum should look like to pull in Well, when we say communities, what does that mean? Does it mean by geographical areas, by subject areas, by particular interest areas or what have you? And I think we need to look at a new way of generating um public uh public input.

[00:27:04] Tom Mitrano: You I want to remind our listeners at this time that you're listening to Pop Radio. I'm Tom Matrano. My guests are Dr. Susan Chandler and Reverend Frank Chong. We're talking about the proper role of state government in providing health and human services. If you'd like to ask our guests a question or make a brief comment, just call 955-8821. Our producer, Susie Roth, will tell you what to expect. She'll put you on hold and then we'll get to you as soon after that as we can. Please be patient. We want your calls. The number again is 955-8821, and our neighbor island listeners, please call collect. Well, Susan, a number of our callers have, and the subject here is talked about efficiencies in government and the ability of the private sector to develop perhaps some flexible ideas.

[00:27:57] Tom Mitrano: We've also seen, for example, in the Department of Education, their development of student-centered schools and school-based budgeting. These ideas really are populist ideas, and are aimed at putting power in the hands of those who possess the power to cure the problems that face them. What are you doing in your department to examine, adopt, implement some of these ideas?

[00:28:22] Susan Chandler: Well, I think they're they're very good ideas, and I think that the private sector does have the ability to move more quickly to meet um needs. I think clearly because we have um because it is a bureaucracy, sometimes the public sector has a much more difficult time hiring people and moving people into different sorts of jobs. So I think that the private sector can play an extraordinarily important uh partnership role in um in helping us understand what the community needs are and making our services more responsive. Uh specifically in the area of child welfare, we are um in the process of reorganizing our uh child welfare services so that they will be more geographically based.

[00:29:05] Susan Chandler: I believe that um we should be examining where our um the children are who are in need of services and get the services there. So we're looking at on Oahu moving the Child Protective Services units into the community. Um in that way, we hope we will be closer to the community, it'll be easier for us to uh coordinate our services with the existing community um leadership there, with the school systems that are there, with the other um public and private agencies. So I think we are um certainly attempting to do this as uh as quickly as we can. for us to hear, and yet I also have to always put that in the context that that doesn't mean that the private sector can always do everything better.

[00:34:39] Susan Chandler: Um it has its own constraints, and uh ultimately the public sector is responsible for many of the mandated services that the department must provide. So our role I think is needs will always be preserved.

[00:34:52] Tom Mitrano: Well, let's hear from the community. We've got Peter holding online one, Peter. Good morning and welcome to the Price of Paradise.

[00:34:58] Speaker 5: Good morning, Tom, good morning, Susan. Good morning, Frank. I I was really struck by uh Susan's comment that they have 80 community advisory groups, and I presume that's in either your department or a couple of others, and by the additional discussion about how we don't have good mechanisms to help guide and steer and make decisions. And I'm just wondering if we had political subdivisions, new political subdivisions below the county level, if they might not indeed and and if those new structures had some small amounts of resources to work with. If that wouldn't begin to solve some of the problems of making decisions of governance, of decision making, and maybe even of some service delivery at the at the community level.

[00:35:44] Speaker 5: It just seems to me that the time is right and but I'd like to hear your comments on how that might affect the Health and Human Services.

[00:35:52] Frank Chong: Frank? Oh, I think there is no question, but we need to find new mechanisms. The the the the the the deadline we're facing obviously is at the federal level. They want to push everything to the state level to be uh to hold leave the state holding the bag. The the big problem I see is that the responsiveness of decision making is very slow and laborious, and it tends to be budget-driven. And when when things are budget-driven, it becomes very much of who you know and the old boy network. And that's not very good planning. The other problem is that we don't have a very stable anything right now. The economy is unstable, the uh governmental structures are unstable, and uh even job security is a bit unstable.

[00:36:34] Frank Chong: So creating new mechanisms, I agree with you very much, Peter, we need to look at either new political alignments or or something that would give the public a feeling that they own the problem as well as the solution.

[00:36:47] Susan Chandler: Susan? I I agree. I think um that certainly some way of moving this discussion into the community is is absolutely essential. Um you know, the African proverb that it takes a community to raise a child. I think that's really true, and I keep focusing specifically on children because that's a a real initiative that our department is working on. But I think that we the systems that we have now um leave people feeling that they don't have a role. leaves people feeling that it's just the state that's supposed to take care of them, and probably that's not a a good bet. So I think um looking for different ways of uh encouraging the citizenry to get active in these kinds of discussions will only happen when there's a a real sense that um your input will be well-received.

[00:37:37] Susan Chandler: And I think perhaps the structures that we have now are are too big and too um centralized.

[00:38:00] Tom Mitrano: This isn't about the things that are important to them, but the one thing we have not really tried to do is to create those political mechanisms in communities, popularly elected, community organizations, neighborhood boards with teeth, if you will, that would really do that and so we keep on reinventing our notions of community, but in fact, we have some structures, and there are experiences in other places, so I really hope that that will be in Hawaii's future. Well, thank you for your call, Peter. Thanks, Tom. Irv from Honolulu is calling in. Irv, good morning and welcome to the Price of Paradise. Morning Tom, Frank and Susan, uh, a couple of things, say. I find it really uh almost amusing that uh y'all have been talking about um uh the the uh uh policy and and development in the community and we've got um a uh process underway in our community called community benchmarks uh Ke Aloha Hoku, which is involved the state, Hawaii Community Foundation, Hawaii Community Services Council, uh the Polynesian Voyaging Society, the Chamber of Commerce, Hawaii Business Roundtable and Aloha United Way, and here is a mechanism that's in place, Susan, that starts with the the vision of 6,000 children across the state trying to understand what kind of Hawaii they want to grow up in and and live in and their children will grow up in and live in. And and although I I am convinced that you and the other uh state folks have really worked hard to figure out a way to make choices on funding, but that is not evident, and we have a process here and I'd like to hear comments from all three of you about whether that's a process that you all can really buy into as a way to get community input.

[00:38:09] Susan Chandler: Susan. Irv, um I think it is a process, and I think it certainly has a role to play. I guess the concern that I have, and this is going to be the first controversial point, I think of the morning, that um I have a question about its representativeness. It can always be a question. We have other groups in Y and I who tell us that um that's not a group that they respond to, that they are um the people who should be telling us how the services should be prioritized. Um I think the Aloha United Way plays a crucial role in our community, and yet there are also people who say, well, how is the Aloha United Way that supports groups like the Cancer Society and the Boy Scouts and the um you know uh cancer uh health heart society, um and Waipahu community, but how are those choices actually representative of what the community wants? I think that as we are looking at what's happening at the federal level, we are getting um assaulted at the federal level with budget cuts, and I think the community is going to have to rethink how we're going to make up for the huge budget cuts that are happening in Congress, and the areas that I'm concerned about, I haven't seen come up necessarily as high priorities among the community. Medicare, Medicaid, general assistance, the various um aid to families with dependent children, the programs that we serve, the the programs that we design in the public sector, so that people have money to live on and have food and have um cash, those are the programs that I think we really have to start prioritizing again. So while community dialogue and visions and outcomes are in extraordinarily crucial to do, I guess at the moment, I'm wondering whether or not that kind of um attempt is going to move us quickly enough to make up for the great losses that we're going to be experiencing probably on October 1st.

[00:38:15] Tom Mitrano: Irv, how in response to Susan remarks, how does community benchmarks uh qualify as a representative of the very community she's trying to serve? Why should that voice uh be heard before or in preference to other voices?

[00:38:16] Speaker 6: I think the the critical element with the Community Benchmarks program is that we are working with as many interested people as we can find and encouraged to get involved, and the idea of the project is that we will have a community-wide vision and a community-wide set of benchmarks Right. that out of which all of the funding groups, the state, the foundation, Aloha United Way and others, will be able to make uh decisions based out of a community-wide effort. I think what's happening now is all of us make our decisions within our frame of reference. That's right. And what has been missing has been the connections between all of the various funding groups. The other thing which I think is really critical is that we have always operated out of principles of scarcity, and we have got to move our thinking to one that it is not a win-lose situation and that it is one of abundance and that we build on the community strengths and assets. That would be the only way that I know of that we can make do with less.

[00:38:22] Susan Chandler: Susan. Right. I um I think that it's important to have a community-wide vision, and I also worry that in my role as the director of Human Services, that I also have to think about the 49,000 individuals who are on aid to families with dependent children right now, who don't have the ability to go to various meetings, oftentimes don't have the childcare or the resources to get to the various meetings, and may indeed as just one example, be a group that's not particularly well-represented in some of these kinds of efforts. That's why when I think what Peter was talking about, when we look at more um local community um in the community on times when the community can do it, though that that to me is an intriguing idea as well. So I think that all of these efforts provide us the um the input from which we need to plan and um and provide services.

[00:38:24] Tom Mitrano: Irv, thank you very much for your contribution. Appreciate your calling. We'll move now to Steve in Kaimuki. Steve, welcome to Pop Radio. You got a brief comment or a question you'd like to ask our guests?

[00:38:26] Speaker 7: Yeah, hello. Uh first of all, my comment is that uh we have been pulled away from becoming a self-sufficient uh economic Hawaii to uh an economic system which is really functioning uh on the uh uh superficial uh quick fixes by the legislature. Uh there are two things which are replica of one another. One is that uh this uh budget cuts and uh the way that they're telling us that they have to cut the budget because uh that that's the uh that's the department that they have to do it uh in and other departments. And education is the main thing that uh concern me because I have been going to the University of Hawaii for a lot of research and my own work, and all of a sudden I found the library is closing at 3:00 and then I started uh trying to help the students to overcome this their uh dilemma, so there were some rallies and everything going on there. Uh what is happening, I think that the uh due to the irresponsibility of some legislature we are facing these problems and they are not telling anybody that what they're doing with those budgets and uh how much of the budget that they're cutting from the education is going to what use. I think this question will remain unanswered the same way as the question that we had on the vote uh the election process and uh uh as long as we haven't overcome the uh vote fraud that is going on in a large scale, has been going on ever since the statehood, and now we have the worst case scenario right now in this last election.

[00:38:30] Tom Mitrano: Steve, you got a question like to ask our guest today about Health and Human Services?

[00:38:31] Speaker 7: Well, my uh my concern was, I mean my comment was, first of all, that, you know, we as long as we have vote fraud, we are not going to have responsible legislatures to do anything for us. Appreciate that. my uh actually my question would be that don't you uh really believe that we have to overcome the main problem, which is the the heart of the issue, that the government representatives have to be from the people before we make any changes whatsoever. Otherwise the the problems will continue indefinitely. And uh

[00:38:35] Tom Mitrano: Well, I Frank, I think uh our caller has focused a little bit on your concern about the legislature, if you'd like to summarize and answer to that.

[00:38:37] Frank Chong: Well, I think that when we talk about community representation, one of the the issues is how do we get people to vote. Uh one of our major problems right now is I think only 52% of the eligible voters are even registered. Uh so I think the issue is a much broader one than just simply the legislature, but it has to do with the community ownership of problem solving.

[00:38:40] Tom Mitrano: Thank you, Steve. May I just We need to pass on to some other callers, appreciate your comment. Make it thank you very much. And I want to remind our listeners that you're listening to the Price of Paradise Radio show. I'm Tom Metrano, sitting in for Randy Roth. Our guests are Dr. Susan Chandler and Reverend Frank Chong. We have some open phone lines, so I invite you to ask our guests a question or to make a brief comment. Our number is 955-8821. If you joined us late and would like to hear the part you missed, tune in tonight when the entire show will be aired again on station KIFO. That's 1380 AM, beginning at 8:00 p.m. Go back to our lines now and talk with David from Honolulu. David, good morning and welcome to the Price of Paradise.

[00:38:44] Speaker 8: Thank you. A quick question on the Children's Health Index, this is for Dr. Chandler. Has the state reduced the percentage of infants born with two or more health defects? I have that chart in front of me. I just wanted to know as a manager, are you familiar with uh that index and have you reduced it or increased it?

[00:38:47] Susan Chandler: I am familiar with the index um and uh I defer that to the Department of Health, which as we began by saying, fortunately, I don't have that responsibility.

[00:38:48] Tom Mitrano: I hope we have.

[00:38:49] Frank Chong: Then then a follow-up question on the benchmarks concept. Yes. Oregon uses a thing called the Oregon Plan. Yes. And uh I believe that if we stood on the shoulders of a giant, we ourselves would be taller. Why haven't you not instituted the benchmarks of the Oregon Plan? The Tom wants to say something, but let me just say that um I am very impressed with uh the way Oregon Oregon has put together its services and um I was there about uh three weeks ago and met with their Department of Human Services people. And uh we are at the Department of Human Services putting together um exactly uh that kind of approach. We are looking to see what indicators we already have within our data systems and then uh establishing a baseline. We will be talking to as many community representatives as we can to um negotiate which are the important benchmarks for us to be working on next year. I think it's a um that Oregon is a real leader in the area of health and human services and um one of the things that's that I think we also need to remember is that Oregon now is in a real boom and growth economy. And so a lot of their their fabulous indicators are in the context of its community its uh economic um setting. I visited their jobs program to look at uh why they were so successful in being able to put so many AFDC women to work. And uh of course, one of the major reasons is that every uh sector of their economy is now growing. It's a lot easier to be quote effective and efficient when you have an economy that is is growing. When we are not in that situation, it's a lot harder for us to demonstrate the effectiveness and efficiency of a of a variety of our programs. But I think the the benchmarking process that they've been through is a is a is an excellent model for us to uh to focus on.

[00:39:05] Tom Mitrano: Well, from the efficiency standpoint, the the question would be like has the state increased the percentage of two-year olds who've been fully immunized against childhood diseases? Since you're going into households, do you check on that?

[00:39:07] Susan Chandler: Yes, we do. Actually, we do that as a part of uh the licensing also for uh for preschools. So we do examine that. And again, that uh the actual technique is done through the Department of Health, but it is something that we have as a as an indicator of uh quality services.

[00:39:08] Tom Mitrano: So is it up or down? It's up.

[00:39:09] Speaker 8: David, thank you very much for your call. It sounds like your comments and those of an earlier caller get together to suggest that maybe what this future of the State Human Services needs to do is focus on those community-agreed-on benchmarks that we can measure and really know that we're making a difference. Thank you for your contribution.

[00:39:10] Tom Mitrano: Like to go next to Rob in Makiki. Rob, good morning and welcome to the Price of Paradise.

[00:39:12] Speaker 9: Good morning, Tom. Uh I'd like to, I really like the show and I'd like to also, I hope our listeners know that uh you, Tom, and Frank and Susan, we're awful lucky in our community that you're lending your talents and experience to try to improve the health of our communities. I know each of you have been very committed to health and human services in Hawaii.

[00:39:15] Tom Mitrano: Rob, we'd like to have you go on with that for about an hour, but our program won't let us, could please. My question. Uh uh as uh seems to me like uh the health and human service sector is going through a sea change here, and as uh boards and communities of uh agencies try to plan for what's ahead, I wonder if maybe you could each comment on the significant trends you see in the future that we might use as input into our own planning, and I stopped along the street because I'm jogging now, and I think I'll just hang up and listen to you all comment, and again, thanks for all you're doing. Thanks, have a good run. We appreciate the call, Rob. Frank?

[00:39:22] Frank Chong: I think some of the new innovative things that are coming about that we are all aware of is uh first of all, I think we're all all looking at national standards, uh other things that are happening around the world. For example, the Oregon experience, uh national standards from national organizations so we all don't have to reinvent the wheel. Another obvious one is looking at ways in which we can do things better uh more efficiently at lower cost, uh things like consolidation, uh collaboration and so forth are are not easy. They're very complicated and may not necessarily save money, but they may make what we're doing um much better. Another one is to involve people in ways that we had never involved them before, and looking at uh problem-solving not from a problem-solving aspect, but really as Tom always talks about, from an assets aspect. Uh let me give you an example. One of the things that we're involved with in the Wikee Health Center, working with the homeless. Uh my my concern always is, how do we advocate for these people that don't have an easy voice? Um one of the things that we've run across is working with the Department of uh Parks and Recreation, you know, rather than working against them, let's work worth them and see, how do we solve this problem of homeless in Kapolei Park? Well, uh believe it or not, one of the things that we're looking at is looking at ways in which we can involve the homeless in keeping the park clean and uh making it a much more uh nice environment for everybody. Uh and one of the rewards that we're trying to get is uh can we get the food coupons or things like uh uh give you a free meal at Jack in the Box or McDonald's and so forth, so we've approached some churches to help help us do that. And so here's a new way of trying to uh keep a particular place healthy for everybody, uh working in collaboration with the Parks and Recreation people, involving the homeless, involving a third party like churches and involving the business sector. So, there they're new ways to solve old problems that we just need to sit down and try and get all the different elements involved and and see if there's some new ways.

[00:39:34] Susan Chandler: Right, I and I think those are very important trends. Um I'd like just add a few from the public sector. Um I think one of the things that's real important for uh the public sector agencies to do is to better coordinate what it's attempting to do. This Tuesday, all of the public sector agencies that work in Health and Human Services are meeting to see whether or not we can't find a better way of both coordinating our own services as well as collaborating to better contract with the private sector. The Department of Health has contracts with the private sector, so does so does um human services, so does labor, so does the Executive Office on Aging, Children and Youth, and we're all kind of in this in a somewhat uh complicated and confusing way. So I think we want to look for much better interdepartmental organization and streamlining. We are all looking for ways to increase the input from the community. We're all looking for ways to decrease paperwork. This governor is a governor who always says to us at cabinet meetings, why, why do you do it this way? Does this make sense? We want to do less paperwork, we want to notice that a lot of the things that we are required to do don't make a whole lot of common sense. Um he's given us a book called The Death of Common Sense, and we're trying hard to uh to ensure that what we do makes sense and is efficient. And um I think that those kinds of initiatives will will help us, um streamline and better understand what we're doing. Just one quick piece and I'm going to leave you get you to back to benchmarking. When I was in Oregon, one of the things that I thought was fabulous about every office that I went to is that on the walls of every Human Service department was what they were doing and in charts, they could demonstrate where they were last January and where they are now in September, and I've encouraged my departments and my units to do that. I think that we all should be, when you walk into an office, and when you walk into the Waipahu Child Welfare office now, you can see on the walls how many clients they have, how many kids have been in foster care for how long, what's the staff turnover, all those important efficiency and effectiveness and quality measures are visual, and I think those are extraordinarily important and that's a trend that I'd like to see everywhere in DHS.

[00:39:42] Tom Mitrano: Well, in response, uh since you had asked the Rob's question about the trends, I do confirm the opinion of other callers today that the future of growth in Health and Human Services is populist, it's community-based, and this benchmarking program that people have been talking about and that Irv described earlier, really is a systematic way of involving the community throughout our state in setting those specific mileposts and and speed limits and priorities that we've been talking about all day. I think that what we will find as the community as the trends develop is that the community will take over responsibility for its own growing health and that the role of government and indeed even the agencies that Frank is representing here today will be to support the populist based, the people based attempts to take control over the solving their own issues.

[00:57:25] Tom Mitrano: It will include many of the changes that the government is talking about here in the state but really will be focused on the grassroots level where people are. Having clarified that point, if I did, I like to go back to our lines and thank Mary for holding, Mary from Kailua for holding for so long, but Mary welcome to Pop Radio, good morning.

[00:57:43] Speaker 10: Good morning. Um I just want to say, I've been a social worker in this community for about 20 years now and um I want to echo what Dr. Chandler just said about the coordination of services between the departments. I'm an employee of the Department of Health and it seems as though we're in a continual battle with the Department of Human Services. I also wanted to mention that um there's a lawsuit right now that hasn't been mentioned the whole state. The Department of Education, Department of Health have been sued over children's mental health issues. And um the definition of mental health issues is very broad including perhaps placement and I'd like to know what Dr. Chandler's department is doing in regard to this lawsuit.

[00:58:24] Speaker 10: I also wanted to mention that um the vision statement, the settlement for this lawsuit is um able to be read by any member of the community in any mental health center right now. So I'll let Dr. Chandler respond.

[00:58:36] Tom Mitrano: Mary, thank you very much.

[00:58:37] Susan Chandler: Thank you. Yes. Um this is the Felix case. Most people know it as the Felix case and um interestingly enough, before I took this job, I was one of the people who wanted the state to be sued so that we could get improved mental health services. Um the Department of Human Services is not technically named, it's mostly um the requirement to get services improved between the Department of Education and the Department of Health. However, we have um we're very concerned about it and many of the children in the Felix suit are foster care children, so we do have a crucial role and a commitment to this um initiative. We um are providing staff support to the um inter agency team.

[00:59:17] Susan Chandler: We are, the Department of Health, Human Services, and Education have met to find a new strategy for pooling resources so that children's budgets can be established in each family. Uh this will be an administrative bill this legislative session. Um I don't know why it was so hard to accomplish in the past, but it was, but now we will be able to focus resources around the family as opposed to having a family have to get what they need from first Human Services, then Health, then Education, then wherever else. So we're looking to um innovatively put together um pooling of the resources and and talents across the departments. So um we are committed to the improvement of services. We are putting Medicaid dollars into this initiative as well and uh I really am optimistic that this plan now is a good one and uh over the next several years will be implemented.

[01:00:09] Tom Mitrano: Mary, thank you very much.

[01:00:13] Frank Chong: Uh sort of in closing, let me just say that one of the things that I think the public sector and private sector need to do is we just need to meet more often on establishing some common ground and some common goals. I think the both both of us, the private sector and the public sector have to be mission-driven in everything we do. And the more that we articulate that, I think the more that we'll find that we have some common areas in which we can collaborate and perhaps make the community a lot better place to live in.

[01:00:42] Tom Mitrano: I'm going to go take our last call here, Bob from Hawaii Kai's been sitting on the line, Bob, are you still there? Welcome to Price of Paradise.

[01:00:48] Speaker 11: Thank you. Oh it seems like we're treating the symptoms rather than the causes. How do we break this cycle?

[01:00:55] Tom Mitrano: Excellent question, Dr. Chandler.

[01:00:58] Susan Chandler: Gee I I I wish in the last minute that that I could answer that. I think that we really must look um to the causes of these problems. Um they are oftentimes within our economic structures as well as um in our communities. Uh we have been focusing a lot today on finding the strengths of communities. I do have tremendous respect for the communities being able to articulate their own concerns and um and take more responsibility for solving their problems. Um it's very hard not to focus on the symptoms because as as Frank's been saying, when you get to the legislature often times the squeaky wheel gets the dollar, um but we are hoping that we'll be able to uh to continue as a community to ensure that uh the most important services are being provided.

[01:01:45] Tom Mitrano: Frank, any response to Bob's question?

[01:01:47] Frank Chong: Well, the, I don't have a particular response to that question, but the good news is that state of Hawaii only has about 1.2 million people. That's not a lot of people. So the problems although we may think that they are very complicated from our little place in the world, uh as related to the total number of people and total dollars available, I think is a is a resolvable issue.

[01:02:09] Tom Mitrano: Bob, I think you may have raised one of the fundamental questions we have had to face all day, really focusing on the difference between the symptoms and the causes. Thank you for calling. Appreciate you supporting Pop Radio. Susan, we've only got a little bit of time left but is there are there some thoughts you like to share at this point?

[01:02:23] Susan Chandler: Well, I guess I wanted to get this in a little earlier, it's not so much a closing point, but I just wanted to um make one comment uh in the paper Reverend Jong said that uh he had not met a civil servant who had lost his job his or her job and I just wanted to say that indeed this uh this governor is extraordinarily interested in decreasing the size of uh state government and has done so and um there are 1,238 jobs that uh will be abolished at the end of this particular effort which will save the state $25.8 million. So I have met plenty of them and it's been one of the hardest parts of my job. Um I think that that still does put our major question in context of um is this being done in the most efficient and effective way, but we are doing it.

[01:03:09] Tom Mitrano: See that our time is about up for today. I want to thank my guests, Dr. Susan Chandler and Reverend Frank Chong for sharing their time and expertise with us this morning. We at Pop Radio believe that public conversations like this one are an essential feature of a healthy community. If you agree, thank our sponsor, the Hawaii Community Foundation. The producer of Pop Radio is Suzie Roth, public radio's director of operations is Jeff Ailarty. I'm Tom Matrono. I hope you enjoyed today's show. One last reminder, the show will be rebroadcast in its entirety tonight at 8:00 PM on KIFO 1380 AM. You've been listening to Pop Radio. I'm Tom Matrono. Aloha.

[01:03:16] Tom Mitrano: some expertise with us this morning. We at Pop Radio believe that public conversations like this one are an essential feature of a healthy community. If you agree, thank our sponsor, the Hawaii Community Foundation. The producer of Pop Radio is Susie Roth, Public Radio's director of operations is Jeff Ilarity. I'm Tom Matrano. I hope you enjoyed today's show. One last reminder, the show will be rebroadcast in its entirety tonight at 8:00 p.m. on KIFO 1380 a.m. You've been listening to Pop Radio. I'm Tom Matrano, Aloha.