Exceptional family member program and payback

[afteranesthesia]

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As stated. Anyone have experience with this? Feel free to pm me also. Newly dx child with needs and now I'm worried about them during my payback which will start in two years.

 

[colbgw02]

I have some nominal experience, meaning I have a family member enrolled but we've never had occasion to "test" the program (never had to PCS after enrolling and all services are available at my current MTF). What are your concerns?

 

[afteranesthesia]

Not getting the services we need in an area near my duty station. Child will need extensive therapies

 

[Gastrapathy]

Are you an inservice resident?

 

[colbgw02]

My consultant and relevant HRC manager(s) have been pretty tuned into EFMP issues. If you are not active duty, and therefore not currently able to enroll your family member, then I would try reaching out to your consultant well in advance. He or she would do well to consider your needs now, rather than run the risk of having to PCS you again so soon after coming onto active duty and enrolling in EFMP.

 

[BigNavyPedsGuy]

EFMP, by definition, will place you in a location where services are available. As stated above, if you currently aren't on active duty then speak with your consultant (the Navy calls them detailers or specialty leaders) about the situation. If they ignore you, file EFMP paperwork as soon as you're at your new command and it will have to be honored. Most consultants will avoid that headache.

I think it's safe to say that pediatricians know as much or more about EFMP than almost any specialty. PM me if you'd like.

 

[afteranesthesia]

I'm civ def for residency in an area with tons of help. More worried I won't get sent somewhere with the same offerings for my child. I'm AF and will be active as an attending in two years.

 

[afteranesthesia]

Anyone know how to find out the consultant for anesthesiology?

 

[Homunculus]

i was chief of EFMP for a couple of years at a MEDDAC. bottom line is it depends on the underlying diagnosis. requiring peds subspecialty support doesn't necessarily mean active duty-- as long as there is availability in your area it's still an "ok" place to go. typically the accepting facility should be inquiried to accept EFMP enrollees-- but like most military systems it's not perfect. for most people it works fine. the people it doesn't work well for are people who want to game the system to either 1) go to a place they shouldn't or 2) not go to a place they can. case in point-- let's say someone "needs" a school or command at a BFE location. child is EFMP enrolled and they can't support a kid with a heart transplant. sponsor says "ok, i will go unaccompanied," gets his/her orders, and PCSs. lo and behold, a couple of months later his family moves on the sly, and the kid shows up in your ER with a fever and splinter hemorrhages. second case-- you are assigned to BFE and your kid has asthma, adhd, IBD, etc. a pediatrician can manage these with some assistance from peds subs at the local academic center a couple of hours away. they can support your child, and you can legitimately get orders to go there. sorry.

EFMP originally came to be due to schooling issues-- DoD schools overseas (typically) that could not provide adeuquate education to meet i think federal law. the medical portion filtered in later. enrollment is mandatory by regulation, and screening should occur for all OCONUS moves.

renewal i think is every 3 years, and allowing it to expire is different than disenrollment. expiration does not get you out of the program, which most servicemembers have a hard time figuring out when they try to get orders and have to deal with EFMP for their kids RAD that resolved years prior.

good luck-- i echo everyone elses comments and recommend getting in touch with your assignments/consultant folks. not because they want to "help you" per se (this may be the case sometimes) but more because if you show up and get EFMPd out it's just more headache for them later to move people around.

good luck

--your friendly neighborhood we don't have a transplant center here at BFE caveman

 

[Homunculus]

I'm civ def for residency in an area with tons of help. More worried I won't get sent somewhere with the same offerings for my child. I'm AF and will be active as an attending in two years.

be careful. some places have loads of convenient support, but this is not considered per se with EFMP. convenience is considered to a degree (primarily travel times) but it is not a requirement that everything be "in house," at the same location, or even same system. as long as the box can be checked that the service is offered-- be it PT, OT, ABA, speech, medical care/supply, etc the quality of that care is irrelevant.

my suggestion would be to start now getting EFMP enrollment completed. it is a rather comprehensive document, and it would behoove you to get it filled out as accurately as possible. civilians can fill it out but it may also be useful to reach out to your closest AF or joint military facility to see how they can help. someone will be the "EFMP" person, you just need to track them down.

--your friendly neighborhood EFMP referring caveman

 

[afteranesthesia]

I need extensive autism services and want all the good therapies not some of them. My child deserves that to continue once I start them

 

[Gastrapathy]

I have two friends with deeply autistic kids. Both elected to remain in the Navy due to the incredible resources that are available to them (better than they could do as private practice physicians). Hopefully you will have the same experience. You can find out who your consultant is a couple ways. You could call the AF GME people you work for now or any AF anesthesia department. Someone will be able to get you a POC pretty easily.

 

[Homunculus]

I need extensive autism services and want all the good therapies not some of them. My child deserves that to continue once I start them

i totally 100% agree, and have fought long and hard in the past for patients and their families to get everything they needed.

that being said, i don't know what services you have available currently, but autism ancillary services are tricky. like i said before, access to these services is all the AF will look at-- not quality and proximity. TRICARE covers ABA which already is a huge benefit to you. i know people who hate their job but stay simply due to TRICARE medical benefits in this arena (ABA) or the subspecialty care that is multitudes more accessible than the civilian side.

i agree with @Gastrapathy -- contact someone to get in touch with your consultant, and i would reiterate finding a local AF or joint MTF to go over this with the EFMP coordinator. you are definitely not alone and they will be able to give you a much better picture of things.

i hope things work out-- keep us posted. and if it is any solace, i think there are fewer BFE locations in the AF than army. 🙂

--your friendly neighborhood BFE avoidant caveman

 

[Homunculus]

also -- IEP and 504 plans will add to your argument. make sure those are documented and discussed

--your friendly neighborhood it's all coming back to me now caveman

 

[colbgw02]

how would the OP go about enrolling his child now? if deferred for residency, then he's in the reserves (probably IRR) and would not be eligible for EFMP, no? he needs this service, which he can't get until he's active duty, before he's on active duty.

 

[BigNavyPedsGuy]

I agree with everything mentioned above. Also, it might be worth trying to track down an AF developmental pediatrician. They are the subject matter experts and would likely know which places are best and/or which ones to try and avoid like the plague. Most consultants have souls, so hopefully this works out.

I was in Oak Harbor, which was EFM Cat 5 (and shouldn't have been). Kids had to travel 2+ hours for every cardiology, endo, heme/onc appt, but we actually had really good access to ABA services within 15 minutes. When I was a resident I watched a Peds Devo guy diagnose an AF child with autism and walk the parents through the process of breaking orders because the place they were going had poor services.

Also, 2 years of ABA can accomplish a lot. A number of kids age out of ABA eventually, some in as little as 2 years. Whatever you do, don't be hesitant to start services for fear they won't be continuing. Again, a lot happens in 2 years. Still go through the EFM process as outlined above, but try and stay positive that you have a diagnosis and are starting services. There will be military hiccups, but often times there are great services available, especially with autism. (and I'm NOT a pro-military guy at all).

Good luck!

 

[Bernardo_11]

Why did I have this gumption to check this thread? hehe.. Well done BigNavyPedsGuy and Homonculus (See? And I bet you two though the DB Peds rotation was mostly fluff and a waste of time, huh?) 😉 I've done some work peripherally with that program even though I'm a civilian, so I do not know the logistics quite like the gentleman here. As a Developmental/Behavioral Pediatrician, I've seen my TriCare patients quickly leave this remote location once they get diagnosed and others get quickly placed into appropriate services, thanks to the EFMP. For the majority of my patients and their families (albeit just a few), the EFMP has been more helpful than burdensome. Otherwise, I really don't have more to add than what the pediatricians have mentioned above.

Best of luck.
'Nardo

 

[afteranesthesia]

Thanks all. I am going to find a dev ped for my child asap here too. This is not an easy diagnosis, but I am going to hope I get stationed somewhere with great services. Travis is the closest I could be put in proximity to family. Hoping for that one maybe.

 

[j4pac]

Good luck, OP. My wife is currently pregnant and I am in the process of being civilian bound soon. I would be lying if it wasn't a bit of a stressor. There is no question that military children with special needs have more resources than those in the civilian sector.