Supporting military children with the services they need, but lost in the pandemic

By Kathy Roth-Douquet via MilitaryTimes.com

A child picks up a stick of chalk during a therapy session at Vogelweh Elementary School April 21, 2016, at Vogelweh Military Complex, Germany. (Airman 1st Class Lane Plummer/Air Force)

As the world faces an unprecedented public health crisis, Americans are witnessing the devastating impact of the coronavirus on daily life. With regular access to groceries, childcare facilities and schooling completely disrupted, if not unavailable, families are forced to alter their daily routines to accommodate their children’s needs.

These real-life adjustments can be difficult for any family, but they are exponentially more difficult for military families who have children and especially those raising kids with autism.

Take the real example of a military family whose daughter is on the autism spectrum and struggles with change under normal, pre-COVID-19 circumstances. The child has developed a deep connection with her therapist, who has extensive training in how to handle change. Since the onset of the crisis, the family experienced a three-week disruption and must now pay out-of-pocket for teletherapy. Hardest of all, the parents must learn how to administer the care once provided by their trusted therapist, while blurring the lines between their role as parents and specialists. For a child who already faces difficulties managing change, this situation can be devastating and lead to regression in key milestones.

While the family has made a commitment to serving their country, they feel like their daughter is not receiving the support she needs.

This family is not alone. As part of the COVID-19 Military Support Initiative (CMSI) tracking the impacts of COVID-19 on military families across the nation, a weekly Pain Points Poll conducted by Blue Star Families and the Association of Defense Communities (ADC) found that one in every five active-duty families with school-aged children reported they have a child with special needs who have lost access to the support services that their school provides.

Without full access to proper health services for children with autism, military families face extreme challenges while they work to increase their child’s language and communication skills, improve their attention, and mitigate behavioral challenges.

On March 30, 2020, the Defense Health Agency (DHA) temporarily extended TRICARE telehealth coverage only to applied behavior analysis (ABA) parent or caregiver guidance services. While DHA’s extension is welcomed, it is critical that the TRICARE extension is expanded to cover direct, one-on-one ABA therapy for Autism Care Demonstration (ACD) beneficiaries.

According to a recent letter co-authored by Partners in Promise, the Youth and Children’s Advocacy Network, and Blue Star Families, now more than ever, ACD beneficiaries need the consistency of continued ABA therapy. Without sufficient access to ABA therapy via telehealth from a qualified provider, some children have been forced to transition from 30-40 hours a week of therapy to none as a result of the pandemic.

While the extension of TRICARE coverage to ABA parent or caregiver guidance services would, in theory, allow parents and caregivers to maintain their child’s continuity of care, DHA has inadvertently added to the burdens of these overtaxed families by asking them to allocate extra time and energy to their dependents’ ABA therapy.

Even before the pandemic, these military parents and caregivers were struggling to keep their heads above water — awash in the myriad responsibilities of tending to a family member with special needs. Now, instead of spending one hour attending to their special needs dependent as they receive ABA therapy via telehealth from a qualified provider, these parents and caregivers must spend twice that — first, learning the ABA therapy themselves, and then administering the therapy to their dependent.

Moreover, military family members cannot be expected to successfully administer ABA therapy as behavior analysts must earn a master’s degree in ABA from an accredited institution and pass the Board Certified Behavior Analyst (BCBA) certification exam before obtaining their license to practice. It is unreasonable to expect that parents and caregivers who lack such education are equipped with the skill sets necessary to administer ABA therapy to their dependents.

Sen. Jerry Moran, R-Kan., recently expressed his concerns over the impact of the coronavirus on service members and their children, highlighting the gap in sufficient coverage for vital health services, and offered his strong support for allowing the dependents of military service members to have proper access to Applied Behavioral Analysis (ABA) during the COVID-19 pandemic.

In a letter to Lt. Gen. Ronald Place, director of the Defense Health Agency (DHA), Moran requests that DHA make ABA care available through the use of telehealth stating, “Typically, military children receive ABA from a board-certified behavior analyst in a brick and mortar location. Military members in Kansas have contacted me to share their frustration with being denied telehealth services for ABA during the COVID-19 crisis…I urge [DHA] to review the ABA Telemedicine policy and allow TRICARE beneficiaries to receive ABA telehealth care for the duration of the COVID-19 presidential emergency declaration that was issued on March 13, 2020.”

There is no script for mitigating the impact of the coronavirus pandemic on our nation’s military families. Military families and ABA beneficiaries are not homogenous in their needs nor capacities, but DHA can help families overcome heightened challenges to daily life by implementing flexible policies and processes allowing beneficiaries to access direct ABA therapy via telehealth under TRICARE. Now is the time to make things easier, not tougher, for military families, serving their country, around the world.

Autism, coronavirus, EFMP

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