By Capt. Scott Taylor, 30th Space Wing Judge Advocate
/ Published July 26, 2011
VANDENBERG AIR FORCE BASE, Calif. -- A significant number of military families have one or more family members that have either educational or medical special needs. The Air Force is committed to meeting the needs of this unique segment of our Air Force community, and offers a variety of services to ensure family members' needs are met. The program aims to ensure appropriate access to information and care, and to prevent untimely relocations from areas where medical services and special education services are not available for family members. The primary considerations are always the safety of family members and the protection of their federal entitlements. Because of the wide range of criteria for inclusion into the EFMP program, the families participating in the program are incredibly diverse. Entry into the EFMP program serves as a safeguard to prevent family members moving to areas that are not equipped to deal with their needs; acts as a gateway into several resources beneficial to family members with special needs; and provides a source of support for Air Force families.
The Department of Defense has provided criteria for identifying a family member with special needs which apply to family members of active duty service members and civilian employees appointed to an overseas location. A member shall receive an assignment limitation code "Q" if his or her spouse, child, or other person actually residing in the members household and who is dependent upon the member for over half his or her financial support and meets one or more of the following criteria:
· Potentially Life threatening conditions and/or chronic medical physical conditions that require follow up support of more than once a year or specialty care. This includes high risk newborns, patients with a diagnosis with cancer within the last five years, sickle cell disease, and insulin dependent diabetes.
· Current and chronic mental health condition, which can include inpatient or intensive outpatient mental health service within the last five years for conditions such as bi-polar, conduct, major affective, or thought / personality disorders.
· A diagnosis of asthma or other respiratory-related diagnosis with chronic recurring wheezing including the scheduled use of an inhaled anti-inflammatory agent, a history of hospitalization within the past five years, or emergency room visits within the past year.
· A diagnosis of Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD) when combined with a psychological diagnosis, requires the use of multiple medications, requires management and treatment by mental health care workers, or requires modifications of the educational curriculum.
· Requires adaptive equipment such as an apnea home monitor, home nebulizer, a wheelchair, splints, braces, orthotics, hearing aids, home oxygen therapy, or a home ventilator.
· Requires assistive technology devices such as communicative devices.
· Requires environmental / architectural considerations such as a limited number of steps, wheelchair accessibility, housing modifications, and air conditioning.
· Has an Individualized Family Service Plan (IFSP), which is a written document for an infant or toddler up to two years of age with a disability. IFSP's are used to provide early intervention services to infants and toddlers who have developmental delays or other conditions which warrant extra services.
· Has an Individualized Education Program (IEP), which is a written document defining specifically designed instruction for a student with a disability for students ages three to twenty-one. In order to receive an IEP, a child must qualify for special education services, meaning a child's disability must have an adverse effect on the child's educational progress.
A member's healthcare provider will make the initial diagnosis and the recommendation to enter the EFMP program. A large number of EFMP eligible family members will be young dependents. Currently, Vandenberg has a Pediatric Nurse Practitioner and anticipates a Pediatrician joining the team shortly. Whatever their age, family members will fall along a wide spectrum of DoD criteria for EFMP criteria. Although Family members may see posters or brochures depicting individuals on one end of the spectrum which may or may not be representative of their family members, that is not to suggest that the EFMP program is not appropriate for any one individual. Entry into the program is the best way to maximize access to appropriate medical and educational care and support as well as find the best services for loved ones. As we will see in the next section, EFMP is not only appropriate for all members whose family members meet the aforementioned criteria, it is mandatory.
One of the more common complaints expressed by EFMP families is the perception that with the restrictions on assignments, it could potentially damage a members career. The intent of the EFMP assignment policy is to use the Air Force member, based on current or projected manning requirements, at locations where required medical, educational, early intervention, or related services as available. EFMP provides an initial twelve month deferment for a newly diagnosed condition when the members' presence is essential in establishing and/or participating in the treatment program. EFMP also provides reassignment when a member is assigned to an area and a new need arises for which the needed services are not available within the assignment locale. Once a treatment program is established, whether formally through EFMP or through the member's own initiative, the member is then considered to be worldwide assignable. Enrolling a family member in EFMP does not negate the member's responsibility to serve his or her share of overseas duty, or in meeting deployment requirements. An EFMP reassignment may be obtained if the Special Needs Coordinator determines that the family member's needs cannot be reasonably provided with the current assignment locale. Family members may be denied travel to overseas locations based upon their needs and the availability of services at the gaining location. Every effort will be made to find an alternative location, or to serve the overseas short tour away from family members instead, but mission requirements come first and there are no guarantees. When an EFMP reassignment is requested, commanders either approve or disapprove of the request, however all disapproval requests must be fully justified.
Understandably, members, families, and commanders become frustrated with reassignments and changes in orders. It is important to keep in mind that inclusion into the EFMP program is both the best thing to do for a members family, and mandatory. Department of Defense Instruction 1315.19 states that when the active duty service member becomes aware that a family member may meet the special needs criteria, the active duty member shall promptly notify the cognizant military authority. The DoD Instruction points out that a service-member who fails or refuses to provide the required information, or who knowingly provides false information may be subject to disciplinary action under the UCMJ. Air Force Policy Directive 40-7 clearly states that when there is evidence that members violated the Family Member Relocation Clearance (FMRC) process either through refusal to fully participate in the screening process or through disregard or official recommendations against family member travel overseas that unit commanders should ensure appropriate actions are taken. The best course of action for a member's family and his or her career is to fully participate so the Air Force can ensure ready access to needed medical and educational support.
Airman and Family Readiness Center Resources
Most families enter EFMP because of a visit to the medical center; they receive referrals to medical care in the local area, and receive the assignment limitation code "Q" which automatically puts procedures in place to prevent an airman from moving to a new location unsafe for his or her family. The Airman and Family Readiness Center has an EFMP coordinator whose job it is to provide information to EFMP families on programs and services that could benefit the entire family. However, The Airman and Family Readiness Center only receives the names of members on the Q-code list but not the diagnosis, which makes the job of providing information that targets the needs of EFMP families very difficult.
Family Support (EFMP-FS) is the community support function provided by the Airman and Family Readiness Center that includes on and off base information, referral, relocation assistance, financial management, and school information. EFMP-FS can provide families with a guide of base and community resources to assist with medical, educational, advocacy, and support group needs. Each resource contains a description of the program, eligibility, services provided, contact information, and the application process. Resources include Disability Rights California, California Child Services, Alpha Resource Center, various TriCare approved therapy programs, and disability specific support and/or advocacy organizations. In addition to being a families best source for information and resources, Vandenberg has EFMP Multidisciplinary Team (EFMP-MDT) for families electing to have their needs assessed. The EFMP-MDT includes representatives from the Medical Group, the Airman and Family Readiness Center, Youth Services, the Base Legal Office, Child Care, and community base resources. The EFMP-MDT meets as a communication forum of the various services available, and helps to assess individual families with either simple or complex problems, and address problems and concerns with each components considerable assets in order to provide appropriate services both on and off base. For more information on how the Airman and Family Readiness Center's EFMP program can help, contact them at 606-0039.
Depending on where a family member falls upon the EFMP spectrum, they are likely to have significant legal needs as well as medical and educational. Every Air Force member needs to consider how best to care for loved ones if something should happen to him or her. A will is a great idea for everyone, regardless of individual situations, but advanced planning is even more important when a service-member has a family member with special needs. If a family member with a disability needs assistance through SSI or Medicaid, the transfer of property through a will or through SGLI benefits can disrupt services. Many services require SSI or Medicaid as a gateway for a recipient to qualify. If a recipient suddenly receives property through a will or SGLI benefits and no longer qualifies for SSI and/or Medicaid, they will similarly no longer qualify for services they count on like group homes that allow for more independence later in life and are placed at the bottom of a long waiting list once they do qualify again.
Proper estate planning can prevent an interruption of services and ensure the care of loved ones even after a service-member is gone. The mechanism to do this is called a special needs trust, which falls within a specialized area of law and state-specific depending on where you are stationed. Unfortunately, unlike military wills, special needs trusts are only valid in the state they are created. For example, California has different laws governing special needs trusts than Colorado, so if you were to move from California to Colorado, you would need a new special needs trust when you arrived. While the base legal office provides a wide range of services, special needs trusts are beyond our scope of expertise. We have, however, made contact with a referral service and can put you in contact with resources to help you get a special needs trust. Given the financial constraints that are constantly restricting EFMP families, we have made every effort to locate attorneys willing to assist military families at a discount while providing quality assistance. Our attorneys at the base legal office can continue to assist you in creating a will appointing guardians, conservators of SGLI money (which cannot currently fund a special needs trust directly), and other associated legal documents.
The base legal office can also provide families with information to make sure they know their rights when dealing with Government entitlement programs, school systems, and any other legal assistance we can provide. We have the resources to make servicemembers the best informed advocates for their family members. Legal assistance is provided Monday through Wednesday by appointment only by calling 605-6207. Additionally, we provide walk in hours every Thursday from 1300 to 1400.
One of the most important aspects of EFMP is the social aspect of bringing similar families together. Certainly, families that move frequently and face similar challenges can and should reach out to one another. Where a servicemember's dependent falls along the EFMP spectrum will affect how much support they need. The EFMP program at Vandenberg AFB has recently launched the "EFMP-Family Support, Vandenberg AFB" Facebook page for just that purpose. It is a great place to go for information, links to informative articles, and social interaction with families going through similar struggles. As the Facebook community grows, so will the social program and events can be planned in the future. Search for the "EFMP-Family Support Vandenberg AFB" Facebook page and click on the "like" icon to join the community and access all the information posted there.
The Air Force is committed to supporting our EFMP families. Help is available for medical, education, legal, social, and any other services we can provide. The Air Force will only assign service members to locations that are safe for special needs family members, which will address the particular medical or educational needs of family members. While families and commanders may get frustrated with changes in orders or separations, safety is paramount. Vandenberg AFB has a team of people dedicated to assisting our EFMP families, but to receive help, families need to be actively engaged with the EFMP coordinator to ensure all of their needs are met. Active participation will increase family members' access to knowledge and services. There is no reason to fight alone; the EFMP team is here to help.