The Exceptional Family Member Program... Is it a "Safe Haven" or a "Hotel California"?

I've been writing a lot of health articles lately. I thought today I'd write a "health related" article that a lot of military servicemembers and their families might be able to appreciate. You see, I am an Army wife, and that means that to some extent, the government controls my life, even though I am not a member of the Armed Forces. When I married my husband seven years ago, I had an inkling of what I was getting into, because I grew up an Air Force brat. But I love my husband and am willing to put up with the government dictating where we live because I know it's a temporary situation. What I am less accepting of is the government treating me as if I am a child. And that's the treatment I got a couple of years ago, when I was forced to enroll in the Exceptional Family Member Program (EFMP).

I'll explain what the EFMP is later. First, here's the backstory...

I spent my whole childhood getting medical care from the military health care system. I was fortunate enough to be very healthy growing up, so it wasn't too often that I needed to use military treatment facilities. I lost access to military health care when I turned 23, but at that point, I was a member of the United States Peace Corps. So, in essence, I got government health care until I was 25.

After I left the Peace Corps, I purchased private health insurance and discovered the joys of civilian health care. Granted, civilian health care was, and still is, a lot more costly than military health care, but for the first time in my life, I had some continuity of care and a doctor who got to see me more than once or twice. When I was 26 years old, I decided to finally do something about the depression that had haunted me for years. I started to see a psychologist for therapy and, in conjunction with that, a psychiatrist for antidepressants.

The treatment was very successful. Within a few months, the psychiatrist had found the proper antidepressant for me, as well as the right dosage. Meanwhile, I was making a lot of headway with my therapist, who was teaching me better ways to deal with my depression and anxiety. It was because of that successful treatment that I decided to go to graduate school at age 27, to earn dual master's degrees in public health and social work. Thanks to effective therapy and antidepressants, I successfully finished a grueling three year graduate program and earned my two master's degrees. It was also during this period that I met my husband, the love of my life, and a Soldier in the US Army.

When my husband and I got married in 2002, I didn't want to give up my private health coverage. I much preferred having a local doctor paid for by private insurance to the impersonal military treatment facilities I had used as a child and young adult. Paying for my health insurance wasn't easy. It was expensive and the premiums went up every year. Moreover, in 2003, we moved into military housing, which put us about ten miles too far north to keep the coverage I'd had for several years. In 2004, when I got a letter from my health insurance carrier telling me I'd have to transfer the policy, I very reluctantly decided to enroll in Tricare Prime.

Those of you who know anything about military healthcare know that Tricare Prime is the "HMO option" for military health insurance. I remained very healthy, though, and never actually sought services from our local military treatment facility. In fact, the first time I set foot in the military hospital that was within walking distance of our home was in 2007. I had to get a physical because my husband and I were moving to Germany.

What is EFMP?

From Army One Source (www.armyonesource.com):

The Exceptional Family Member Program (EFMP) is a mandatory enrollment program that works with other military and civilian agencies to provide comprehensive and coordinated community support, housing, educational, medical, and personnel services to Families with special needs. Soldiers on active duty enroll in the program when they have a Family member with a physical, emotional, developmental, or intellectual disorder requiring specialized services so their needs can be considered in the military personnel assignment process.

Family members must be screened and enrolled, if eligible, when the Soldier is on assignment instructions to an OCONUS [overseas] area for which command sponsorship/Family member travel is authorized, and the Soldier elects to serve the accompanied tour. This screening consists of medical records review for all Family members, and developmental screening for all children 72 months of age and younger.

Soldiers are responsible for keeping their EFMP enrollment current as exceptional Family member (EFM) conditions change or at least every three years, whichever comes first.

I referenced an Army Web site because I am an Army wife, but all branches of the military have the EFMP program. For some families, it truly is a lifesaver, since it requires assignment coordinators to consider family members' medical needs before making a permanent assignment. Some people are very happy to enroll in EFMP and actually seek out the service. However, for other people, particularly adults with minor medical problems, EFMP can be a real pain to have to deal with, especially when a servicemember is being considered for an assignment overseas.

Becoming an "exceptional family member"

In June of 2007, my husband was deployed to Iraq and I was trying to get us ready for our impending move to Germany. One of the tasks I had to complete before we could move was have an EFMP screening. I had not been particularly good about seeking health care, in part, due to a very bad experience I'd had with a military doctor before I joined the Peace Corps. The EFMP screening required me to submit ALL of my health related records from the previous five years to the EFMP screener, as well as submit to a physical exam. I dreaded the exam, but managed to get through it thanks to a very patient and kind hearted physician's assistant who was on staff at the military hospital.

Aside from the notes from that physical in 2007 and the records I had from an allergist I'd briefly seen in 2003, I didn't have many records from medical doctors to present. I spoke to an EFMP coordinator at Walter Reed Army Medical Center who told me I must gather whatever records I did have, including (and perhaps especially) the notes and records from the psychologist and psychiatrist I had seen for my depression. Though I was extremely reluctant to share the very personal records from my mental health treatment, the screener warned that my husband could get in serious trouble if I didn't comply and they found out about it. Since my husband was in Iraq and I couldn't easily discuss the issue with him, I reluctantly got the records and showed up for my screening.

My EFMP screening...

Before I went to my EFMP screening, I had heard many different accounts of what the appointment would be like. Some people had said it had consisted of just a phone call with a doctor with a rubber stamp. Other people said they were interviewed and had discussed their family's medical and educational conditions with the EFMP screener. In my case, I was greeted by a young female Army doctor in uniform who took my records to her office and left me sitting alone in the waiting room of the pediatrics office. I must have sat in the waiting room for a good half hour before the doctor came out and handed me the completed screening form. She had already checked the box that indicated that I needed to be enrolled in the EFMP.

When I questioned her, she said my EFMP enrollment was necessary because I'd undergone mental health treatment. She was concerned that if I went to Germany with my husband, he could get deployed and I might get depressed again. I looked the doctor in the eye and said, "Lady, my husband is already deployed. I'm not depressed right now." Then she said that being in a foreign country would be very stressful for me, which might also cause me to relapse. I then told her that Germany would be my third experience living overseas; the second time I was overseas was as a Peace Corps Volunteer in a developing country. I managed to deal with depression just fine during that time with fewer resources as a Volunteer than I would have as an Army wife.

Then... to add insult to injury, the doctor said, "You're lucky your husband is going to Germany. I think there are plenty of mental health providers there. If he was going to Hawaii, you would probably have to stay behind because there aren't enough mental health providers there."

By that point, I was getting seriously irritated with the doctor. I probably gave her one of my trademark evil eyes when I reminded her that I have master's degrees in social work and public health. The Army could hire me to be a mental health provider! Moreover, I highly doubt Hawaii lacks mental health providers, though they might not be employed by the military. The doctor then told me that I could try to disenroll from EFMP in two years; at that point, it would have been five years since I last took antidepressants and they might let me out of the program.

I could see that arguing with the doctor was going to get me nowhere. She was clearly following orders and covering her own interests. So I turned the form in to the local EFMP coordinator and had a chat with her about how stupid I felt this situation was. She actually agreed with me and, in fact, was preparing to leave her job to go back to graduate school for her master's degree in social work. She had herself been an Army wife and understood how the rigid rules could cause more problems than they solved. But nevertheless, she took my paperwork and forwarded it to Walter Reed for review by the head EFMP honcho.

Meanwhile...

My husband came home from Iraq in August. We were due in Germany by mid September. We didn't hear anything about my EFMP status, which was kind of worrisome, since we knew that sometimes overseas assignments get changed or cancelled at the last minute due to the EFMP. Sometimes, the receiving installation decides the exceptional family member either cannot get the appropriate medical treatment or educational assistance locally, or it would be too costly or troublesome to access it. In such cases, the servicemember could get reassigned, or worse, he or she may still have to go overseas for as long as two years while the family stays behind.

Luckily, no one in my husband's new job seemed to care at all about my EFMP status. We went off to Germany without a hitch. About six months after we got there, my husband got a nastygram from the EFMP coordinator at Walter Reed in Washington, DC, asking him where my paperwork was. I was enrolled in the program and they needed to be apprised of my "condition". My husband sent a note back saying that I had no interest or desire to be in the EFMP and he wanted to know how I could disenroll. We never heard another word about it. We spent two glorious years in Germany and I never once got depressed. My husband wasn't deployed again, either.

What's wrong with this picture?

I have done some informal research about other peoples' experiences with the EFMP. A lot of people praise it and think it's a wonderful program. It allows families with special medical or educational needs to access services and even live in special housing, if need be. But I've also found that a lot of people had experiences similar to or much worse than mine. I was lucky enough to have only one insulting encounter with a clueless doctor who didn't know me from Adam and was basing her assessment on what she'd seen in my medical records. Some people had their assignments cancelled or were forced to make the tough choice of splitting up temporarily. Other more fortunate people were able to change diagnoses or get them lifted from their family members' records so the system would let them take certain assignments and take their family with them. It seemed to depend on the individual servicemember, their branch of service, and who he or she knew.

Some people who were dealing with the EFMP before an overseas move actually chose to accompany their servicemember overseas without "command sponsorship"-- that is, they went overseas without the protection of the military. They paid for the family's transportation over there and lived there without having access to U.S. facilities like the commissary, exchange, or most importantly, medical services. They also lacked the all important SOFA (Status of Forces Agreement) stamp that allows family members to legally live overseas without getting in trouble with local immigration authorities.

Forced EFMP enrollment might discourage people from getting help

One major problem I have with forced EFMP enrollment, particularly regarding mental health treatment, is that it punishes people for seeking help for mental health issues. People with mental health issues already often face a stigma that may discourage them from getting treatment. That stigma can be especially problematic in the military, which has an official policy of requiring servicemembers to seek help for mental health issues, but tends to punish them for doing so. Military officials often say that seeking mental health treatment does not adversely affect a servicemember's career, but the reality is that it frequently does. It's not unheard of for a servicemember to lose his or her security clearances after seeking mental health services.

Family members who don't work for the government or a military agency don't generally have to worry about losing security clearances. But if a career minded servicemember is required to disclose all medical and mental health conditions affecting family members to the EFMP, doesn't it stand to reason that the servicemember might not want his or her spouse to seek treatment for a mental health problem because it could mean a potential assignment will be cancelled or the family might have to be separated?

I know I may have thought twice about getting much needed treatment for my depression had I known that one day I would marry a Soldier and we might not get to go to Germany together because someone in charge decided I might get depressed again. I thought I was doing a good thing by getting help for my depression. It never occurred to me that as the wife of a Soldier, getting necessary treatment might actually be held against me.

Don't get me wrong...

I do see the need for EFMP and I can understand why it's an important program. I think it's especially important for people who have children with special needs as well as adults who have medical problems that seriously impact their lives. However, in my experience, the EFMP was less about really caring about the family members and more about the military trying to avoid liability. I can agree that it's important for the military to avoid liability, but not at the cost of forgoing common sense.

EFMP screeners should be encouraged to use their own judgment when they are assessing people for the program. EFMP might have been appropriate for me if I were someone who was still dealing with anxiety and depression, lacked international experience, was obviously emotionally fragile, and actually wanted to be enrolled. However, I am someone who has lived abroad three times and has extensive training in mental health issues. Telling me that I might "get depressed" because my husband might be deployed-- especially when he was already deployed-- was, in my mind, ludicrous and insulting. Moreover, I knew that the EFMP didn't really have my best interests in mind, so I resented the paternalistic insinuation that the EFMP was there for my own good and that a medical professional who had never actually examined me knew better than I did what was best for me.

It would not have helped my marriage or my mental state to see my husband get sent to Germany for two years while I stayed behind. The EFMP would not have been doing either of us any favors. And while some might argue that the EFMP helps the military be more efficient by not spending money to send family members with medical or educational needs to a location where they can't access services, I would argue that servicemembers are more effective at their jobs when they can be with their families, especially when one of those family members has a medical problem.

In my opinion, it would be much more appropriate for EFMP screeners to treat servicemembers and family members as stakeholders in the process of getting necessary assistance for their families and allowing them options in that process. As a competent adult I expected, but was denied, the opportunity to discuss my medical situation with the doctor who did my screening. As a competent adult, I would have appreciated the ability to choose whether or not I wanted to be enrolled in EFMP. If I had a medical condition that really warranted it, I very likely would have voluntarily complied.

I can understand why the military makes the program mandatory, but I also think their rule is misguided, particularly when it comes to adults. From my observations, people who are faced with unwanted EFMP enrollment seem to do whatever they can to fudge the paperwork or somehow work the system to get around it. Look at what happened in my case. I was enrolled and didn't want to be. My husband wrote an email and that was that. But other people have not been so lucky and have had to deal with the stigma of the EFMP for years.

Anyway... I expect that this issue will soon become moot for me, since my husband only has a few years to go before it's time to retire. But this was an issue I wanted to get off my chest, since I know it does affect a lot of servicemembers and their families.

Source: www.armyonesource.com