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Monday, September 3, 2001



Molokai kids to
lose friend because
of consent decree

A beloved doctor's new role will
preclude tending to most of
his longtime child patients


By Crystal Kua
ckua@starbulletin.com

The word "compassion" comes to mind when Yolanda Tanielu describes child psychiatrist Ronald Snead -- a doctor, friend and confidante to the children and families of Molokai.

"He's very famous on this island," Tanielu said. "We love him."

Trust is precious to residents of this island, a place that has struggled to improve special-education services for its children, an island that has seen doctors and other mental health professionals come and go in the process.

Snead -- the gray-haired epitome of the country doc -- has clearly won the hearts of folks on the Friendly Isle.

"I don't trust my children to see anybody else," said Tanielu, who has a 7-year-old daughter with autism and a 13-year-old son with attention deficit hyperactivity disorder.

But Tanielu and other Molokai parents of children covered by the Felix consent decree -- the federal mandate to improve educational and mental health services to special-needs children -- are worried about losing Snead's valuable medical know-how and charm.

"We need him," said Ruth Manu, who has two sons with attention deficit hyperactivity disorder.

"One symptom under Felix is the changing people," said Colleen Wallace, executive director of the Mental Health Association in Maui County. "You can't have all these changes."

Except for a few "high-end" cases, Snead will not be continuing direct care to the children of Molokai once new contracted psychiatric services are in place, and he will mainly become a consultant to Department of Education staff.

"I will not be doing this after they get a new (child psychiatrist)," Snead said. "I will be working in the guidance centers and seeing just a few kids."

The consent decree -- named for a special-needs student whose lawsuit led to the 1994 court order -- aims to bring the state into compliance with federal law by improving educational and mental health services to children with disabilities.

The state's special-education system, however, faces being taken over by the federal government if two-thirds of school complexes -- high schools and their feeder schools -- are not in compliance with the consent decree and key benchmarks are not met by Nov. 1.

Molokai has been cited as one of the consent decree trouble spots, with challenges that include the state having difficulty recruiting candidates to fill much-needed crucial positions on the island.

Snead is an associate professor of psychiatry at the University of Hawaii medical school but is assigned to the Maui Family Guidance Center, run by the state Department of Health, under a program aimed at recruiting quality psychiatrists to hard-to-place locales and training up-and-coming doctors.

"We get better training programs, and we get better services to the community," said Dr. Alfred Arensdorf, medical director of the Department of Health Child and Adolescent Mental Health Division.

Snead, who also has provided psychiatric services to Hana and Lanai, arrived on Molokai four years ago to provide medication monitoring and evaluation, and flies to Molokai from Maui twice a week.

But it took two years before he gained the trust and respect of the residents.

"I love these people, I love these kids, I love the families, I love Molokai," Snead said. "It's fulfilling to me and it's useful for them."

Parents say Snead takes the time to make the entire family comfortable.

"He's been really attentive to Molokai," Manu said. "My sons love him."

Snead goes beyond the call of duty, visiting children at their homes and checking on their progress in school if need be, parents said.

"He's very open, he's very good with families, he's very compassionate," Tanielu said. "The rapport is really great."

But more important, these parents say they have seen their children make remarkable progress under Snead's care.

"I can see the difference," said Eldridge Spencer, whose 14-year-old son is the oldest autistic child on the island.

Tanielu said that her daughter, Tiffany, has opened up to Snead in ways she has not seen before.

"He takes the time to talk to Tiffany even if she doesn't want to," Tanielu said. "She comes up to him and gives him a hug."

Snead said working directly with children brings him the most satisfaction, but there are elements in this situation that are beyond his control.

"The direct care is what I most enjoy and the thing I thrive on," he said. "There are a lot of factors that figure into that."

Snead said he understands the reasons this four-year relationship will be dissolved, but he knows it will not be easy on the families.

"There's a great deal of anxiety right now," he said.

Beginning July 1, the consent decree required that the Department of Education begin taking over providing many of the direct services now provided by the Department of Health to special-education students in a move toward school-based services.

Because Snead works for the Health Department, the services he provides will now be taken over by doctors contracted by the Department of Education.

"We don't expect any gap in service as a result of the changes," said Carl Yoshimoto, the school-based behavioral health program coordinator for the Maui School District, which includes Molokai.

Contracts with private psychiatrists already are in place to continue medication evaluation and monitoring and other psychiatric services, Yoshimoto said this past week. "One doctor went in last week to begin transition."

Arensdorf said his department wanted to lighten the caseload, concerned that Snead would burn out. At one point he was responsible for 290 kids.

Arensdorf said that no changes will take place unless directed by a child's individualized education program, which sets out services for special-needs children.

"The Department of Health isn't doing any abrupt ending of service to anyone," Arensdorf said.

"What's the meaning of abrupt?" asked Tanielu, who also is chairwoman of the Molokai Community Children's Council.

Tanielu said it will not be the same for Molokai families without Snead, and many parents have said they would protest any move to take him away from the island.

"If we ever get a hint, we have decided to make signs and go to picket the Department of Health," Tanielu said.

Parents also worry, she said, that any change to their children's care could affect work toward complying with the consent decree. "It could hinder compliance."

Snead said that he would like to be involved in any transition that could include him introducing the families to any new practitioner.

"My hope is that the trust that (the families) put in me can successfully be put in the next transition," Snead said. "My hope is that they can make the shift and that there can continue to be progress."



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