FSJ: MED’s Focus on Clearances and Restricting Access to SNEA #NotSupportForFamilies

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.

 

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@StateDept’s Mental Health Services Drive Employees with Special Needs #FSKids Nuts

Posted: 12:26 pm ET

 

The Department of Defense Education Activity (DoDEA) operates 168 schools in 8 districts located in 11 foreign countries, seven states, Guam, and Puerto Rico. All schools within DoDEA are fully accredited by U.S. accreditation agencies. Approximately 8,700 educators serve more than 73,000 DoDEA students. This is what it says on special education:

Special education is specially designed instruction, support, and services provided to students with an identified disability requiring an individually designed instructional program to meet their unique learning needs. The purpose of special education is to enable students to successfully develop to their fullest potential by providing a free appropriate public education in compliance with the Individuals with Disabilities Education Act (IDEA) as implemented by DoD Instruction 1342.12, “Provision of Early Intervention and Special Education Services to Eligible DoD Dependents.”

In DoDEA, special education and related services are available to eligible students, ages 3 through 21 years of age. To be eligible for special education: the child must have an identified disability; the disability must adversely (negatively) affect the child’s educational performance; and the child must require a specially designed instructional program. DoDEA recognizes clearly defined categories of disabilities with specific criteria for determining eligibility such as physical, communication, emotional and learning impairment, and development delay.

The State Department does not have its own schools so Foreign Service children go to local schools and avail of local school services. Is the State Department required to meet the requirements of the Individuals with Disabilities Education Improvement Act (IDEIA) with regard to the education of special needs children overseas? Here is what state.gov says:

No. The Individuals with Disabilities Education Act (IDEA) and its 2004 reauthorization, the Individuals with Disabilities Education Improvement Act (IDEIA), are federal funding laws ensuring a free and appropriate education to children with disabilities in the United States. IDEA/IDEIA governs how states and public agencies provide early intervention, special education and related services to eligible children and youth. While existing law does not require DOS to replicate what a public school would provide to a student in the United States, our goal is to approximate what a child would receive in a good US public school system. Per the Overseas Differentials and Allowances Act and the Department of State Standard Regulations (DSSR), the IDEA/IDEIA framework is the basis for the allowable reimbursable services for the Special Needs Education Allowance (SNEA). DOS is committed to assisting employees in meeting the necessary expenses incurred when deployed overseas in providing adequate education for their school-age children. The education allowances are designed to assist parents in defraying those costs necessary to obtain educational services which are ordinarily provided free of charge by public schools in the United States.

Prior to 2013, we understand that the State department took a flexible, supportive approach that ensures support for dependents while creating maximum flexibility for Foreign Service employees to serve overseas. In October 2013, SNEA management was switched to the then newly created Child and Family Programs (CFP).

The Department’s Standardized Regulations or DSSR was also amended to state that “There must be a formal Individual Education Plan (IEP) or equivalent prepared by a professional medical or educational expert which delineates the educational services required to provide for the child’s special needs.  Reimbursement may only be for those services provided for in the IEP which are actually required, as opposed to those services which a parent or school may recommend as desirable.”

Between 2013 and early 2017, we were informed that “SNEA benefits are reined back dramatically.”  Previously authorized uses were  either denied or dramatically restricted.  One parent told us, “No explanations or justifications are provided for the change in policy despite many requests.  At the same time, parents are increasingly challenged by CFP staff, often rudely, about the way in which they plan to educate their children overseas.”  A direct suggestion that the parent curtail his/her assignment was not unheard of.

That suggestion may become more real for parents of approximately 1400 special needs children in the Foreign Service. We understand that in spring 2017, the Office of Allowances formally ruled that 1) based on DSSR language the only dependents who can receive SNEA are those specifically given a MED clearance that allows them to reside full time at post; and 2) No other clearance is sufficient (such as a Class 6 that allows for a child to reside at post outside of the school year in a boarding school situation).

What was the result of this official determination? Apparently, MED started “aggressively” issuing Class 5 clearances to children with educational, mental health and other disabilities even though there are many/many overseas posts where services have been and could be provided to successfully support such children.  It was reported to us that when challenged, MED doesn’t back down, claiming that their decisions are in the best interests of the child since “everyone knows” that only the “mildest” of special needs can be met in an overseas school situation.

Class 5 medical clearance means  domestic only assignment and it is supposedly issued “to those with complex medical conditions.”

For the FS employees with approximately 1400 special needs kids, a Class 5 medical clearance for a family members potentially means 1) DC/domestic assignments for the foreseeable future only; 2) an overseas assignment that leaves the family at home on a voluntary separation, or 3) back to back to back unaccompanied assignment to priority posts while the family stays behind in the United States on a voluntary separation.  We understand that not all these kids are given Class 5 clearance now but as their clearance gets reviewed, families anticipate that the numbers will continue to grow.

“It appears that any child deemed to have “moderate to severe” needs is being given a Class 5 at the time a MED clearance review is triggered.”

When we inquire about potential issues with the SNEA funds, our source speaking on background told us that SNEA has “always been under the administration of MED, and SNEA spending could only be reimbursed after approval by MED authorities.”  We were told that previously, in some cases SNEA was allowed to be used “for therapies that some would argue were either non-traditional or perhaps not fully established as effective” so the source said it is understandable to see the need to standardize the application of SNEA when the Child and Family Programs (CFP) was created and took over management of SNEA. But the source also said “it doesn’t explain the inflexibility CFP staff have employed since” when dealing with families with special needs FS kids.

Who’s doing this and why? Families are pointing at the MED/MHS (Mental Health Services), which oversees the Child and Family Programs (CFP) in the State Department’s MED org chart.  That office is headed by Dr. Kathy Gallardo, the former Deputy Director and now Director in MED/MHS. She reports to Dr. Charles Rosenfarb who is currently the Medical Director of the Bureau of Medical Services. Dr. Rosenfarb reports to the Under Secretary of Management, an office that sits currently vacant and is overseen by the “M Coordinator” and Acting DGHR Bill Todd, who in turn reports to somebody inside Secretary Tillerson’s 7th Floor bubble.

As to why? Well, no one seems exactly sure why. The State Department does not talk to this blog anymore for juvenile reasons but we cannot overlook the elephant in the room. The State Department is looking to cut cost across the board. We expect that it will be looking at everything and inside every cupboard to come up with its desired 37% cuts.  How many families will endure the separation with employees deploying overseas, and families staying behind because their special needs children are not authorized to be overseas?  Last year, Bloomberg  reported that Secretary Tillerson was seeking a 9% cut in State Department staffing with majority of the job cuts, about 1,700, through attrition, while the remaining 600 will be done via buyouts.

So in the case of the special needs FS kids, the State Department is potentially hitting two birds with one big rock? Anyone at State/MED wants to chat, we’re happy to talk and update this post.

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Photo of the Day: Excuse me? Who is this person, and why is he redesigning my playtime?

Posted: 2:32 am ET
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Via state.gov:

Secretary Tillerson Greets Staff and Families at U.S. Embassy Riyadh
U.S. Secretary of State Rex Tillerson greets U.S. Embassy staff and their families at the U.S. Embassy in Riyadh, Saudi Arabia, on October 22, 2017. [State Department Photo/ Public Domain]

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