We’ve blogged previously about the problems encountered by Foreign Service families with the State Department’s Bureau of Medical Services (see StateDept’s MED Services Drive Employees with Special Needs #FSKids Nuts; Also @StateDept’s Blackhole of Pain Inside the Bureau of Medical Services (MED). The latest issue of the Foreign Service Journal features a piece by James Brush who previously worked as a child psychologist at the State Department.
Via FSJ: James Brush, Ph.D., is a child and adolescent psychologist in private practice in Washington, D.C. He worked at the State Department as a child psychologist with the Child and Family Program division of MED Mental Health from January 2013 through March 2016. Prior to his work at State, he had a private practice in Cincinnati, Ohio, for 26 years. A past president of the Ohio Psychological Association, he continues to be involved as a committee chair.
Below is an excerpt from The Demise of MED’s Child and Family Program (FSJ)
The Child and Family Program within the Bureau of Medical Services’ Mental Health program was constituted in 2013, when the full team was finally in place after years of planning. I was brought onto the team as one of two child psychologists. By March, we had on board a child psychiatrist director, two child psychologists and three clinical social workers who had experience in treating and managing the needs of children and adolescents.
I was on the ground floor of this program, and our mission was both exciting and challenging. This was the first extensive effort within the State Department to support the specific mental health and developmental needs of children, adolescents and their families living abroad.
By 2015, three of the psychiatrists who were opposed to the CFP functioning as a comprehensive support program ended up having leadership roles in MED. Dr. Stephen Young took over as the director of mental health. Dr. Kathy Gallardo took over as deputy director of mental health, and Dr. Aleen Grabow was brought in as a child psychiatric consultant. Together, they worked toward limiting the scope of the CFP, limiting the SNEA program and reducing the opportunities for families with disabled children through more restrictive use of child mental health clearances.
Within a year of their tenure in leadership, we lost our child psychiatrist director, the two child psychologists and one clinical social worker. I and the other providers left because Drs. Young and Gallardo changed the mission and scope of the CFP. It became an unpleasant place in which to work, with the emphasis being on clearances and restricting access to SNEA. Support for families was no longer the focus. Rather, support services were being cut and the clearance process was being used to restrict the opportunities of those with disabled children.
The program is now a skeleton of what it was previously, with only one social worker, one child psychologist and one retired Foreign Service psychiatrist. Telemedicine is forbidden. The program now basically performs an administrative function, processing clearances and SNEA requests.
Read the entire piece here.
We understand that State/OIG is aware of some allegations related to the special needs education allowance (SNEA) and is doing “exploratory work”. Well, Dr. Brush’s account should be instructive. This is not one of the employees battling the bureaucracy on behalf of their children, this is one of the people who used to work at MED.
While we might be tempted to think that the troubling response could be some form of retaliation for blowing this issue up in the media, it is hard to imagine that MED’s policy and focus on restricting access to SNEA and the medical clearance do not have the full blessings of the State Department leadership all the way to the 7th Floor. After all, if State really wanted to resolve these cases, it would have worked with these FS families to accommodate their needs, avoid forcing people into taking loans to pay/repay for special ed needs expenses, and it would have afforded families an appeals process (IT. DOESN’T).
And they certainly would not/not have threatened people who pursue this issue, right? RIGHT?
Perhaps, this is what they mean when they talk about the new Department of Swagger? Take it or leave?
(Thought bubble: How long before the proponents of this policy get promotions, Superior Honor Awards or Presidential Rank Awards?)
While the State Department has lifted the hiring freeze, and the A-100 classes are no longer on a hit and miss schedule, it is not clear to us what the new secretary of state’s position on the previously planned 8% shrinkage of the agency workforce. If that was a WH imperative as opposed to Tillerson’s, it would be hard to imagine Secretary Pompeo going against it.
The CRS report on the Department of State, Foreign Operations and Related Programs: FY2019 Budget and Appropriations dated April 18, 2018 and updated on August 9, 2018 notes the following:
The Department of State released guidance in May 2018 lifting the hiring freeze and allowing the department to increase staffing to December 31, 2017, levels. Subsequent press reports indicate that the department intends to hire 454 new employees beyond end of year 2017 levels but also suggest that hiring must be circumscribed by previous commitments former Secretary of State Rex Tillerson made to reduce its workforce by 8%.
So this brings us to the “take it or leave” scenario for FS employees with special needs children. Since these kids are given limited medical clearances with no appeals (which precludes most if not all overseas assignments), Foreign Service families will be forced to serve either in domestic assignments in order to stay together; serve separately with employees going overseas, while their families stay in the United States, or employees may opt to pay everything out of pocket and not ask for SNEA to avoid getting snared in MED’s clutches.
Begs the questions: 1) How many career employees would stay on when their employer talk the talk about supporting FS families but know it’s just a gum chewing exercise? And 2) Is this what a slow walk to 8% looks like??
By the way, if there’s an alternate reasonable explanation for all this that does not require our relocation to the parallel universe, Earth, Too, send us an email, we’d love a good chat.
- Senators Murray, Menendez Demand an End to State Department’s Harmful Actions Toward U.S. Diplomat Families who Have Children with Disabilities (Press Release. August 16, 2018)
- It Sure Seems Like Mike Pompeo Doesn’t Care About Diplomats’ Special Needs Kids (Law&Crime, August 15, 2018)
- Pompeo Ignores Plea from Diplomat with Children with Special Needs (Foreign Policy, August 14, 2018)
- @StateDept’s Blackhole of Pain Inside the Bureau of Medical Services (MED) (Diplopundit, April 5, 2018)
- U.S. Diplomats Stuck in Medical Limbo (Foreign Policy, April 2, 2018)
- Families with Special Needs Kids Need Support (FSJ/Speaking Out by Kathi Silva, March 2018)
- @StateDept’s Mental Health Services Drive Employees with Special Needs #FSKids Nuts (Diplopundit, January 23, 2018)
- State Department support for diplomats with children with disabilities is contracting (WP, October 29, 2017)
- Supporting FS Families with Special Needs Children (FSJ/Speaking Out by Maureen Danzot and Mark Evans, June 2016)