Premium ContentMouse over Home then click on Premium Content for information.LINCOLN — A key state lawmaker is rethinking the idea of carving out a special children's agency from the Nebraska Department of Health and Human Services.
The proposal was a key recommendation from a legislative study of child welfare.
Now State Sen. Kathy Campbell of Lincoln, who led the study, says there may be better routes to improve services for Nebraska children.
"We're working on that whole concept now," she said. "What is the best, most direct way to focus and get at this problem?"
Campbell said she is looking at several options, including having a "children's czar" in HHS who could work on coordinating services and programs.
Another possibility would be to leave the question of whether to create a Department of Children's Services in the hands of a proposed children's commission. The commission was also recommended by the legislative study.
The Health and Human Services Committee launched the study out of concern about the state's two-year-old experiment in privatizing child welfare services.
The history of agency reorganizations gives reason for pause about creating a new department.
Fifteen years ago, cost-shifting, bureaucracy and a lack of coordination were among the reasons given for undertaking the massive reorganization of social services and health agencies that led to HHS.
"We literally have instances where the left hand doesn't know what the right hand is doing," then-Gov. Ben Nelson said when he unveiled the proposed change.
The 1997 reorganization brought together five state agencies and offices under a common administrative umbrella.
Organizational lines within the mega-agency were redrawn in 2007. Again, backers said structural changes would improve an agency criticized as difficult to work with and lacking in accountability.
Six new divisions were created, and the agency's top official was given more power.
"The primary goal is to make (HHS) more accessible, more accountable and more effective for Nebraskans," then-Sen. Joel Johnson of Kearney said at the time.
But, according to the study released in December, poorly coordinated services, gaps in care, layers of confusing bureaucracy and cost shifting among state programs remain problems within HHS.
As a result, the needs of children and families may not get met.
The family of a troubled child, for example, could have Medicaid decide therapy is not medically necessary, find a waiting list for behavioral health services, and find themselves forced to relinquish custody so the child welfare system can pay for care.
Kim Robak, who led the 1997 reorganization effort as lieutenant governor, says now that the changes did not produce the desired results.
In particular it did not break down the funding and administrative "silos" that keep programs from working together for the benefit of children and other vulnerable Nebraskans.
"What they weren't able to do is eliminate the bureaucracy," she said. "It's even more bureaucratic than it used to be."
Robak said she believes it may be time for another structural change. She said a separate department focused on children makes sense.
"I don't know why structures are sacrosanct," she said. "Just because it (reorganization) didn't work in the past doesn't mean you shouldn't try it."
Kerry Winterer, the CEO of HHS, argued against the idea. Carving out children's services from the rest of HHS would create new silos and new coordination problems, he said.
It could separate services for children from services for their parents. It also could force children needing ongoing services, such as those with developmental disabilities, to make a transition from the children's agency to the adult agency.
Winterer acknowledged that services could be better coordinated but said there are other ways to achieve that goal without spending time and effort on structural change.
"That seems to me to be a distraction that would interfere with providing services," he said.
He suggested looking at a children's coordinator position in HHS or at a separate children's division within the existing agency. A coordinator could focus on the rules and funding requirements that often create conflicts and gaps.
But others say the recommendation for a children's agency holds promise. They support Legislative Bill 821, which calls for a children's services department to start July 1, 2013.
The department would bring together all state children's services, including programs in child welfare, behavioral health, developmental disabilities, public health and Medicaid.
The children's commission, which also would be created under LB 821, would determine details about the department.
Sen. Gwen Howard of Omaha, who lived through the 1997 reorganization as a state child welfare caseworker, said setting up a separate agency would be a step in the right direction.
"I think it stands a chance of providing the services that children and families need," she said. "I know it's better than what we have now."
Contact the writer:
402-473-9583, martha.stoddard@owh.com
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