The Foreign Service Journal, September 2018

THE FOREIGN SERVICE JOURNAL | SEPTEMBER 2018 13 LETTERS-PLUS T he Child and Family Program within the Bureau of Medical Services’ Mental Health program was constituted in 2013, when the full teamwas 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 psychia- trist 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. We were to bring the various child welfare activities under one roof, allow- ing for a continuum of care for children and adolescents and their families. This meant that child mental health clear- ances, administration of the Special Needs Education Allowance (known as SNEA) and child medical evacua- tions for mental health reasons would be managed as a seamless activity. In addition, a new range of services was to be offered. We were provided telemedi- cine units and were charged with developing a telemedicine program offering clinical sup- port to the medical providers around the world in U.S. missions. Because the mental health needs of children and adolescents are a specialty that few of MED’s pro- viders have, the CFP was to offer guidance and support to those working “on the ground” with State Department families. We were also to develop a program of brief mental health consultation through the use of telemedicine. This type of support has been requested by families for years and is still very much needed. This program was not only to support families, but to try to reduce the medical evacuations of children and adolescents with behavioral health problems. The typical medical evacuation of a child or adolescent for a behavioral health problem lasts about six weeks, with evalu- ations and treatment taking place in the United States. And it usually involves a child or youth who has not been “on the radar” through the clearance system. In other words, the typical behavioral health medical evacuation is of a child or teen who has not previously been known to be having problems because child and teen behavioral health needs are usually not chronic and crop up because of life circumstances or trauma. Medical evacuations are extremely disruptive for families, often requiring family separation or entire families leaving post and temporarily relocating for evalu- ation and treatment of the child or teen and the family. It is also very disruptive to a mission, which often must do without an employee for an extended period of time. Further, medical evacuations are extremely expensive, when accounting for the costs of relocating and housing a child and perhaps an entire family, the evalu- ation costs and the treatment costs. The cost savings would occur from improved triage and brief treatment for those with conditions that can be easily resolved or supported at post. Examples of medical evacuations pre- vented by telemedicine consultation while we were piloting this program include a preschooler who had toileting prob- 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. Response— The Demise of MED’s Child and Family Program BY JAMES BRUSH Here is another contribution to the discussion thread on support for Foreign Service children with special needs that began with the Speaking Out by Kathi Silva in March (“Fami- lies with Special Needs Kids Need Support”). The May FSJ contained a response from Dr. Charles Rosenfarb, medical director of State’s Bureau of Medical Services (“Our Commitment to For- eign Service Families”). Letters in the April, May and July-August editions added to the conversation.