Office of Child and Family Programs

Mental Health and Special Needs Support for FS Children

What is the role of MED’s Office of Child and Family Programs and when was this office created?

The role of MED/MHS/CFP is to help parents of children with behavioral health conditions and educational disabilities navigate the overseas environment and identify those posts where the child’s needs may be met. MED/MHS/CFP also provides clinical and administrative support to Foreign Service Medical Specialists who oversee the health and welfare of the dependents of COM personnel overseas.

Was CFP created as part of the overall MED reorganization?

No. CFP was created in 2013 to bring educational and mental health clearance functions together in one office and to improve oversight and standardization in supporting FS families with children.

What responsibilities did CFP take over from ECS?

CFP took over the educational clearance consultations and Special Needs Education Allowance administration from ECS and the mental health clearance consultations for school-age children from the general Mental Health Services (MHS) consultation program.

What services does CFP provide and for whom?

The current scope of work for CFP staff is five-fold: 1) Case review for educational clearance recommendations to MED Clearances for school-age children of USG personnel assigned overseas. 2) Intensive case management of the SNEA program, involving eligibility determinations, annual renewals and authorization of allowable expenses for USG dependents from 0-21 years old. 3) Case review for mental health clearance recommendations for school-age children of USG employees assigned overseas. 4) Consultation for pediatric and adolescent behavioral health medical evacuations from DOS providers in overseas locations to domestic venues for urgent assessment and treatment. 5) Clinical consultations for DOS MED Foreign Service Medical Specialists (FSMS) overseas.

What services does ECS provide and for whom?

ECS provides voluntary confidential employee assistance program services in person, by phone or video to Foreign Service and civil service employees of the Department of State and the United States Agency for International Development to help identify and resolve personal concerns that affect job performance. Family members do not have access to services, except in the case of marital conflict where the employee would like the spouse to participate in short-term counseling. Types of services include: 1) individual and couples short-term counseling 2) workplace grief interventions 3) Compassionate actions (Curtailments, 6/8 Waivers, LWOP, Break in Onward Assignments and Domestic only extensions for Diplomatic Security Agents) 4) Education on a variety of workplace topics 5) Family Advocacy Program case administration. Contact ECS at MEDECS@state.gov.

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? If so, how does it do that?

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.

Can you clarify which offices —MED/ECS, MED/CFP, FLO, Office of Overseas Schools, other —are responsible for which elements of diagnosing and supporting FS children with mental health or special needs issues? What office manages support for special education services overseas? Which office decides on the provision and authorization of the Special Needs Education Allowance? Can you elaborate on the responsibilities of the different offices?

The MED/MHS/ECS office provides expert administrative oversight for the DOS Family Advocacy Program, tasked with prevention and response to allegations of suspected child abuse, child neglect and domestic violence involving all persons subject to chief-of-mission (COM) authority at posts abroad.

MED/MHS/CFP responsibilities are: 1) Case review for educational clearance recommendations to MED Clearances for school-age children of USG personnel assigned overseas. 2) Intensive case management of the SNEA program, involving eligibility determinations, annual renewals and professional verification of allowable expenses for USG dependents from 0-21 years old. 3) Case review for mental health clearance recommendations for eligible family members of USG employees assigned overseas. 4) Expert consultation to DOS medical staff for pediatric behavioral health medical evacuations from overseas locations to domestic venues for urgent assessment and treatment. 5) Clinical provider to provider consultations for MED personnel overseas.

The Family Liaison Office (FLO) offers a comprehensive range of resources and services for US government direct-hire employees, their family members and members of household (MOH) who are serving, have served or will be serving at posts abroad. Contact FLO’s Education and Youth team at FLOAskEducation@state.gov

The Office of Overseas Schools promotes quality educational opportunities at the elementary and secondary level for the children of U.S. Government employees working under COM authority abroad. Annually they compile a list of overseas schools offering support to children with special needs.

The Office of Allowances administers all allowances, including educational allowances. With guidance from MED subject matter experts, the Office of the Legal Adviser and other offices, it implements the DSSR provisions.

The Office of Allowances, the Office of Overseas Schools and the Family Liaison Office work together to assist families with children. During the bidding process or once you have been assigned, you may want to contact the Office of Overseas Schools for background information on available schools and on resources in the community. The Regional Education Officer (REO) will be able to tell you which schools and services other American families are using.

At post, the RMO/P is a local resource available to help manage a child or adolescent’s mental health needs. Contact your Health Unit to find out who the RMOP for your region is.

Making sure a child with special needs is provided with the necessary educational facilities at an overseas assignment requires cooperation and assistance to the families from various offices. How is this assistance being coordinated?

Staff members from the Office of Overseas Schools, the Office of Allowances, the Family Liaison Office and the Bureau of Medical Services meet regularly and ad hoc to collaborate on projects, to review overlapping services and to ensure employees have access to the most updated information. Additionally, the Bureau of Human Resources works closely with all bureaus to manage available opportunities and support employees throughout their careers.

If appropriate educational facilities are not available at the employee’s post of assignment, or at the post to which the employee will be traveling on assignment within the next six months, does CFP and/or the Office of Overseas Schools assist the employee to find a school away from post? If so, how?

Generally, no. If an appropriate school is not available at the employee’s post of assignment and the child’s needs cannot reasonably be provided for with SNEA assistance, a child would not be medically cleared to be at that post and the employee could seek another assignment if early in the bidding cycle or request a compassionate curtailment if only discovered late in the process. Additionally, DOS provides alternatives for employees whose eligible family members’ needs cannot be met, which include application for Separate Maintenance Allowance, a domestic assignment or request for 6-8 waivers (where applicable). In the situation where a parent chooses to send an adolescent to a boarding school, it is the parents’ responsibility to find a school that meets the teen’s needs. A teen’s current educators and clinicians are in the best position to help a parent understand his/her teen needs; however, the office of Overseas Schools and MHS/CFP may be of assistance in providing guidance on ways to go about finding an adequate school. In some urgent and severe situations, approval for the use of an educational consultant may be authorized by CFP, approved only in advance.

What resources are available to Foreign Service families who need assistance finding appropriate educational facilities for a special needs child—either at or away from post as necessary—before the employee goes to his or her assigned post?

Educational resources for parents of a special needs child seeking an overseas assignment can be obtained through the Office of Overseas Schools, the Family Liaison Office or the Bureau of Medical Services. General guidance to parents includes:

  • Contact the Office of Overseas Schools and discuss your child’s needs with a Regional Education Officer.
  • Review the schools of interest websites for descriptions of the level of disability/need they will consider.
  • Email or call the schools of interest to discuss your child’s needs to ascertain the level of learning support (if any) available and ask whether they would consider your child for admission. The school will need all records and updated information but may not be willing to provide a binding review or opinion without a formal application. While a school may not respond in the affirmative, it may be able to give enough information which would allow a parent to eliminate that school.
  • Ask the RMO/P for the post to review the documentation as it currently stands to see if your child’s needs are in the ballpark of what might be met at post based on knowledge of the schools and local clinical services (therapies, medications, etc.)
  • The Overseas Briefing Center’s Post Info to Go is a good resource.
  • Always check with the Office of Overseas Schools and the CLO for updated school information.
  • Have frank discussions with your child’s current teachers and clinicians about prognosis, rate of progress and projected needs.
  • Talk with the Regional Education Officers from the Office of Overseas Schools about their knowledge and experience of the schools of interest.
  • Make sure CFP has all documentation from school and providers in order to be able to help you decide what has the highest chance of success.
  • Stay in close contact with CFP as you progress through the process and you have more information about your child’s needs as time approaches
  • There are many unofficial resources out there which can be helpful. However, the information reliability is variable. TalesMag posts candid reviews from parents about their school experiences for most posts. Keep in mind, things can change rather quickly at a post so don’t go back too far in time.

In the past, SNEA funds could be used to hire an educational aide to assist a special needs child in an overseas school, and we understand that now these requests are being denied. Has the policy on the use of SNEA funds changed? If so, can you spell out the new policy and clarify the reasoning behind it? What are the alternatives to SNEA funding for educational aides for FS families?

The policy related to hiring para-professional educators for a child underwent revision in 2014, and reflects the serious concerns observed overseas with their use. First, it is important to understand that para-professionals in a US public school have college degrees, work under the supervision of a credentialed special education teacher and are only appropriate under certain circumstances, for certain children. Overseas, with rare exception, classroom “aides” or “shadows” are not para-professional educators, do not work under the guidance of a credentialed special education teacher and are instead “teacher extenders” who make the teacher’s life easier but offer little to a student in the way of education or support. Many overseas private schools will only accept some children for admission on condition that the parent hires an aide. CFP would consider this a denial for school admission and a child would not be cleared for that post. If, because of a child’s special needs a para-professional is required on an IEP, it may be an allowable reimbursable expense if a child was accepted at a school which hired and vetted its own para-professional/aide and billed the parent for appropriate hourly services, commensurate with the child’s need. Problems encountered by parents who have hired their own aide include consequences resulting from non-compliance with host-nation labor laws, risks related to child abduction, child abuse/neglect and lack of specialized knowledge and experience for working with special needs children. SNEA does not fund training, travel or room and board, etc. for para-professionals.

Alternatives to SNEA funding for educational aides not approved under the current guidelines would include parent self-pay, or working with a CDO for an alternate overseas or domestic assignment with a school where a child’s needs can be met.

Under what conditions will MED approve away-from-post SNEA for a special needs child?

MED may approve SNEA away-from-post allowance for special needs youth who have significant educational needs that cannot be accessed at post and who require specialized services through the school.

What is the requirement and process for obtaining approval to send a special needs child to a boarding school?

A disabled child may be approved to attend a specialized boarding school using the SNEA-away-from-post allowance, when there are significant educational requirements which cannot be met at post and there is a professional recommendation for the child to be educated in a more restricted environment. Each case is reviewed on an individual basis.

In the past, SNEA funds could be used to cover the services of an educational consultant for researching possible placement of a child in a boarding school when parents are or will be assigned overseas to a post that does not have an adequate school. Is that no longer allowed?

The policy for approving an educational consultant has not changed since it was developed in 2009. Hiring of an educational consultant using SNEA funding is a very rare allowable expense and may only be considered for approval under acute situations for SNEA-eligible youth who require Therapeutic Boarding School admittance after being expelled from a school at post, after a medical evacuation or in specific cases of domestic violence where services are not available at post. Eligibility is defined by the urgency and severity and the immediacy of need the absence of any alternative.

What advice can you offer families with a special needs child for bidding on assignments? What do they need to know before bidding on a post?

Parents of special needs children really need to invest time in researching posts, schools and available resources based on what they know about their child’s needs. It is important to understand that in general, children with special needs are best accommodated in a US public school and most private international schools do not have special education programs or even basic learning support capabilities and at the present time do not find these programs sufficiently laudable to develop. The reasons are multi-factorial and include as well as the cost of a well-staffed special education program and extreme difficulty finding well-trained and experienced staff if they had the funds.

Parents should also be aware that many schools “over-promise” what they can provide and will accept students either out of lack of understanding of special education by US standards or with the expectation that SNEA will fund a shadow teacher for the class if things don’t work out.

Parents should also know that with research and persistence, adequate schools can be found. It may not be at the post of first choice, but not having to worry excessively about a child’s development and education may be worth it.

The Department of State Standardized Regulations (DSSR) indicates that the SNEA can be used to cover homeschooling expenses, and under U.S. law parents have the right to homeschool a child with special needs. Does the State Department consider homeschooling to be a viable option for a child with special needs overseas?

DOS authorizes a homeschooling allowance for parents who choose to homeschool their children, whether or not they have special needs. If a homeschooled child has special needs, the case will be reviewed on an individual basis for what services may or may not be approved for reimbursement.

What is the rationale for granting a Class 2 medical clearance to children with stable, non-medical disabilities that require educational support? In other words, what is the reason for treating an educational need as a medical condition?

Every educational disability is based on a medical condition and has both a Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) medical classification code. All specific learning disabilities have either a neurodevelopmental or brain-based etiology. The clearance process is the appropriate mechanism to ensure a child’s medical and educational needs can be met at any given post.

Mental Health Support

Does or can CFP (or another office) provide early preventative face-to-face consultations with FS families overseas when a family needs assistance or advice while at a post overseas?

For clinical concerns, clinical consultations are available from the FS Medical Specialists, specifically the RMO/P for behavioral health and special education concerns. CFP can and should be contacted for administrative information about the clearance process or SNEA at any time. This can be by phone or DVC. CFP staff members also encourage parents to make an appointment when in DC and come in to the office to discuss their child’s educational needs.

We have heard recently from families concerned that medevac or curtailment are currently the default responses to any mental health issue with a child at post. Is that accurate?

Many mental health issues in children and adolescents are managed at post, depending upon the type and severity of the condition and the available local resources. Serious mental health issues which can’t be stabilized at post may take place as a medevac or privately if a parent so chooses.

Can you offer any guidance on how families can distinguish between problems that can be managed at post and those requiring departure from post?

This would be done in consult with the medical providers at post in consultation with the RMO/P.

Is MED able to manage an FS child’s mental health issues at post on a long-term basis?

Medical staff at overseas Health Units may be able to manage many FS children’s mental health issues at post on a long-term basis, when stable. Because RMO/Ps have extensive regional responsibilities and Mission health units are only equipped for primary care capabilities, severe and acute issues cannot be managed at post. Rarely, a severe issue requires stabilization locally before returning to the US but most conditions are best managed in the US for medical, security and safety reasons.

Are there plans to use A/V technology (e.g., Skype) bearing in mind that a curtailment could be more expensive and disruptive in the longer term than keeping the family at post?

At the current time, DOS security regulations preclude the use of Skype in Mission facilities. However, MED/MHS RMOPs use tele-therapy extensively within their region via an encrypted system on the Department’s secure internal network.

Some families are using tele-therapy options for some interventions where possible. However, it has been our experience that many tele-therapy providers do not understand their legal and clinical responsibilities when they agree to provide care using this modality. However, when a private provider chooses to provide care in this manner and finds the patient appropriate for this then MED is unlikely to have any problem with it. MED/MHS strongly encourages patients to consult with their medical insurance provider to ascertain if tele-therapy is a covered benefit and suggests use of insurance paneled providers to assure appropriate credentialing, scope of practice and responsibility. Reports from these providers should also be submitted at the time of a medical clearance update.

Not all conditions or all patients are appropriate for tele-therapy. You should discuss this with your current provider who will make the determination. It is important to consider bandwidth capability at post as well as security concerns if you are considering tele-therapy.

Does the State Department collect and compile data on the incidence of mental health issues, including PTSD, in Foreign Service children? Do you see a greater incidence of mental health issues in the FS child population than in the U.S. child population overall?

MED is in the process of developing a more advanced electronic health record (EHR) which will be implemented in the next few years and will allow greater ability to analyze data related to its patient population. Many FS children do extremely well living overseas but this population has not been comprehensively studied.

What are the “Class 2” posts for mental health?

MED does not designate posts as class-specific. Determining whether an individual’s needs can be met at any particular post varies widely and is considered on a case-by-case basis. All individuals with Class 2 medical clearances are given post-specific clearances.