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'Where will we go?' Kajsiab House, Hmong mental health program, closes after 18 years

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Xao Her at Kajsiab House

Xao Her, an attendee at Kajsiab House. 

After Xao Her’s husband died in 2004, the Kajsiab House was her refuge. She healed in the community support and therapy program at Journey Mental Health Center created specifically for Hmong individuals like her.

Her husband’s death wasn’t her first hardship. Her husband and sons were recruited to fight for the U.S. in the Vietnam War and the family was forced to flee its home after the communists took over. But sharing her struggles with friends at the Kajsiab House brought her “bliss,” she said this week through a Hmong interpreter.

“It’s like I cannot breathe at home, and when I come here, I can breathe freely again,” she said.

But Kajsiab is closing, and she cried as she talked about it.

“If we don’t have Kajsiab House anymore I’m not sure what I’m going to do. I’m not sure how people like me are going to survive,” she said.

After 18 years, the healing program for the local Hmong community is closing on Sept. 28 due to a funding problem. There are disputing accounts explaining what led to the shortfall, but total agreement that it’s a heartbreaking loss for Madison’s Hmong community.

“It’s devastating to Journey. It’s devastating to this community. I am devastated about having to make this decision,” said Lynn Brady, president and CEO of Journey Mental Health Center.

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Kajsiab House

Participants gather around midday at the Kajsiab House program. 

REFUGE FOR REFUGEES

“Kajsiab” (pronounced “ga shee’ah”) is the Hmong word for “relief of stress and tension and the freedom from worrying about the safety of loved ones,” according to Journey’s website. The program aims to provide that relief to over 100 attendees, including refugees and veterans who fought for the U.S. in the Vietnam War. 

Some attendees suffer from post-traumatic stress disorder, according to Journey, and program manager Doua Vang said most came to the U.S. with histories of trauma. The program was created in 2000 to help battle a cultural stigma against mental health care, he said.

The building that houses the Kajsiab is lined with faded carpet, covered in chipped paint, and furnished with mismatched chairs gathered around tables, but Her said it makes her truly feel the “kajsaib." Art sketched by participants in marker and colored pencil lines the walls, each labeled with an English caption.

Some pieces recall a past in the home country: “This is a picture of my home back in Laos. I planted vegetables. Off in the distance are the beautiful hilltops. It makes me happy when I think about my home in Laos.”

Some pictures touch on trauma: “The war tore my family apart. I am not happy. I worry and feel empty. My son remains in the old country. My children’s lives are separated.”

Others are evidence of the simple hope Kajsiab House offers: “I am happy that I am here at Kajsiab House.”

At Kajsiab, there’s culturally sensitive mental health counselling and therapy. The program also picks clients up from their homes and provides a variety of wrap-around services, helping clients fill out the paperwork for Social Security and food stamps, teaching English and citizenship classes, serving daily meals, and offering Bingo games and community discussions.

Even events as simple as Bingo are purposeful, Vang said: the game can help the participants identify sounds, letters and numbers, useful for tasks like signing their names to documents and making phone calls.

The program model, created explicitly for the Hmong community with professional mental health staff and accompanying services, is unique. Vang said it’s the only one of its kind in the U.S.

“There is no program out there that will greet you in your language, that will pick you up in your language, will give you counseling in your language, will feed you your own food that you eat and (allow you) to interact with people on a daily basis that look like you,” said Mai Zong Vue, a Hmong community leader and a longtime Kajsiab House volunteer.

Yang Sao Xiong, an assistant professor of social work and Asian American studies at UW-Madison, agreed.

“It’s a space that’s hard to come by even in the city of Madison. You’d think there’d be a lot of facilities for this, but there are few spaces for older adult Hmong men and women to come and gather,” Xiong said.

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Art at Kajsiab House

Art created by a participant at Kajsiab House, a Journey Mental Heath Center program offering community support and therapy program for the local Hmong population.

'WE CAN'T RISK THE ENTIRE ORGANIZATION'

An important part of the program is providing transportation to clients to and from the center, and that’s where the funding deficit reared its head.

States are required to fund non-emergency medical transportation for Medicaid recipients. The state of Wisconsin contracts with Medical Transportation Management to oversee Medicaid and BadgerCare Plus transportation.

As a for-profit broker, MTM does not own vehicles or provide rides, but rather contracts with ride vendors. Journey contracted with MTM as a vendor for $250,000 and certified Hmong-speaking drivers to bring participants to the program, Brady said.

But the partnership broke down after MTM sent an email to Journey “exploring new rates,” Brady said. From there, accounts diverge.

Journey says they tried to respond, asking what MTM meant and what they wanted, but received no response. They found out MTM had terminated their contract when MTM sent new drivers to pick up their clients in February, Brady said, with “no notice, no plan of transition.” Kajsiab clients wouldn't ride with the new drivers who didn't speak their language, Brady said. 

MTM disputes this account. In a statement, MTM said didn’t receive a reply from Journey and “subsequently awarded the work to another reliable transportation provider." They then met with Journey to ensure “interruption without service,” they said. The State Journal reports that Middleton-based Richwood Transport received the contract and eventually started using Hmong-speaking drivers as it was clear clients would not otherwise come. 

MTM also said they did not cancel their contract with Journey, but that their contracts “do not guarantee any level of trip volume.”

Journey continued the Kajsiab program while they attempted to find a fix, keeping their own Hmong-speaking drivers on because clients trusted and could communicate with them, even though their time was no longer billable, Brady said. Attendance and billable services dropped, and the projected deficit will be around $600,000 by the end of the year. 

“If there was any way that we could avoid doing this we would. But we can’t risk the entire organization for this deficit in this program,” she said.

Vue believes the funding shortfall came via the incompetence of Journey staff.

“We want to hold Journey accountable for their negligence. My understanding is they lost the contract because the staff did not do their job,” Vue said. “I think that is a very huge and costly mistake because now the elders don't have a place to call home.”

DEVASTATING

There may be disagreement about how the program ended, but no one is downplaying the loss.

“I really want people to know about it and to know what a loss this is for Dane County -- not just for vulnerable Hmong refugees, but Dane County as a whole,” Brady said.

Journey will continue to provide services to the Hmong population, and is bringing some of the Hmong staff from the Kajsiab House to serve in outpatient services, Brady said, “but what works for this community is the model, and that’s the model that we’re losing.”

Vang served clients who came to Kajsiab with a history of suicidal thoughts and suicidal attempts, but since the program’s start, they have had no hospitalizations or suicides, he said. Vang is worried that when the program closes, the risk of psychiatric hospital visits and suicide will increase.

Her is left with questions.

“Are they closing Kajsiab House down because the participants did something wrong? Have we eaten too much food? Did we not bring enough money?” she said. “Without Kajsiab House here, where will we go and see my friends again? I just don’t know what to do.”

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