The Foreign Service Journal, September 2018

14 SEPTEMBER 2018 | THE FOREIGN SERVICE JOURNAL lems and a school-aged child who had developed school phobia. I was involved in 10 consultations in our pilot program that were mild problems being considered for medical evacuation simply because there were no local treatment options. All the children and teens improved while maintaining the family at post. The Child and Family Programwas also charged with tightening proce- dures in the administration of the SNEA program. The SNEA program had been inconsistently administered, and policies and procedures for SNEA had drifted from State Department rules and regulations and from the spirit of the Individuals with Disabilities Education Improvement Act of 2004 law and other disability laws on which it was based. Many parents were upset by changes in how SNEA was administered. The new CFP worked closely with the Office of Allowances to assure adherence to the policies and procedures governing SNEA and the Foreign Affairs Manual. We scru- tinized services paid for by SNEA carefully and communicated more with financial management officers. Our goal was to include all stakeholders in the process, to be more transparent and to be more consistent in decision-making. Our hope was that in five years, a more comprehensive and robust program of support for children and families would be in place, with clear policies and procedures, so that families would find ample support from MED in taking care of the behavioral health and developmental needs of their children. We expected growing pains, and we expected there would be a need to educate employees about how to use the various programs being developed. We expected a lot of individual work with families to link themwith needed services. We expected a need to request changes to SNEA and other processes that would need upper management direction. What we did not expect was suspicion and animosity from our State Department colleagues and many in the MED leader- ship. We thought everyone was on board with this new program. But we found that many MED psychiatrists, some members of the Office of Overseas Schools and some within the Family Liaison Office were prepared to torpedo the CFP from the start. I never understood the opposi- tion to the program by members of the Office of Overseas Schools and the Family Liaison Office. We had been told when we began that the CFP was part of a strategic initiative developed by MED and upper State Department management that was intended to consolidate support services for Foreign Service children and their parents living abroad: the SNEA process, the child educational clearance and child mental health clearance process, and the medical evacuation process for children and teens. By 2015, three of the psychiatrists who were opposed to the CFP func- tioning 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. This was a very sad, missed oppor- tunity for the Department of State to support their employees with families abroad. I hope for the sake of State Department families that the idea of the Child and Family Program can be revived. But, if so, it will need full- throated support from upper manage- ment so that it cannot be subverted by those with a different agenda. n This program was not only to support families, but to try to reduce the medical evacuations of children and adolescents with behavioral health problems.