Leaders Guide - Exceptional Family Members

The Exceptional Family Member Program is a mandatory enrollment program (MCO P1754.4A) for all active duty personnel and active reservists. The primary objective of the Exceptional Family Member Program (EFMP) is to ensure that Marine sponsors (and Navy personnel assigned by the Marine Corps) are assigned to locations where services exist to support their Exceptional Family Member (EFM). This is especially critical in overseas assignments where the provision of medical or educational services may be limited. Assigning Marine sponsors to locations that can support the medical or educational needs of their family members ensures that the sponsor’s performance of duty is not inordinately affected by the demands of caring for their EFM. This allows the sponsor to concentrate on performing duties and contributes to the operational readiness of the Marine. Successful execution of the EFMP also improves the quality of life for Marine Corps families with special needs.

As leaders, it's important that you understand the impact that a condition can have on a family when a child or an adult family member is an EFM, usually it is the spouse of the Active Duty Marine who bears a lot of the work and stress. Active Duty member's duties and frequent deployments, spouses often make and attend appointments, coordinate home medical care, handle the medical bills attend and negotiate goals and services at special education meetings and do most of the research about their child or family member's condition. Family Readiness purpose, is for the sponsor to have a Family Care Plan and even more important for them to be continually aware of the family member’s medical plan of care, especially with regards to daily care, prescription medications and signs that would indicate the need to seek emergency medical attention when the spouse is unavailable.

The stress of providing care, the burden of medical expenses, plus the high cost of hiring someone to provide care, make it difficult if not impossible for some Marines (or Corpsmen) to be able to afford even a few hours of respite care. These Marines rarely ask for help because they worry about the perceptions of the leaders in their Chain of Command and how that perception may impact their career. These Marines often quietly endure the burden of caring for a profoundly disabled, seriously ill, or terminally ill family member alone, and cannot receive support from the EFMP Coordinator when they are not enrolled in the EFMP or are not aware of the EFMP.

Marines are not required to share the medical condition of family members (Privacy Act of 1974). However, you should be aware of any family readiness concerns the Marine and their family may have, and watch for “red flags” that may indicate the need for additional support or the need to recommend that the family move to a location that can better meet the family member’s needs. Also watch for signs that the prolonged stress associated with the challenges of supporting a family member with special needs 24 hours a day, 7 days a week may have become too much to bare, such as, charges or indicators that there has been maltreatment, abuse and neglect towards the family member with special needs or other family members.

Many Marines with family members with significant medical needs remain in the Marine Corps because they feel they cannot afford civilian medical insurance for a family member with a pre-existing condition, therefore, retention doesn't appear to be an issue for this population of Marines. Marines who have a special needs family member and have become accustomed to and successful in supporting their family member's daily needs are typically successful Marines because their daily home life has given them some very valuable attributes such as multi-tasking, handling enormous amounts of stress, and responding to emergencies. In addition to the installation EFMP Coordinator, these incredibly resilient Marines are an excellent resource for you to send junior Marines to for guidance and support, because they were or are in similar situations and understand the associated financial and emotional hardship and challenges.

Every family member going overseas on accompanied PCS orders is required to complete Overseas Suitability Screening. Regardless of the category, the sponsor is always eligible for deployments or overseas assignments. Enrollment in the EFMP does not prevent a Marine from going overseas for any length of time.

CATEGORIES:: The EFMP category definitions are:

Category I: EFM enrollees whose medical or educational condition requires monitoring by the CMC (MRZ-2) EFMP Manager, but does not preclude the sponsor's assignment to overseas or isolated duty stations, nor requires assignment near a major medical treatment facility.
Category II:EFM enrollees whose medical or educational condition requires special placement in compatible geographic areas, pinpointing assignment in CONUS or overseas.
Category III:EFM enrollees are generally excluded from accompanied overseas assignment. The medical or educational condition of this category of EFM precludes the assignment of the sponsor to an accompanied overseas location based on non-availability of medical or educational services. However, sponsor is eligible for an unaccompanied overseas assignment.
Category IV: EFM enrollee requires family to be assigned to a location near a major medical treatment facility, either military or civilian (preferably military), IN CONUS ONLY. However, the sponsor is eligible for an unaccompanied overseas assignment.

Exceptional Family Member:: An authorized (DEERS enrolled) family member (spouse, child, stepchild, adopted child or dependent parent) residing with the sponsor, who possesses a physical, intellectual or emotional disability or condition and who requires long-term special medical or educational services.
Exceptional Family Member Program:: The Exceptional Family Member Program is a mandatory enrollment program (MCO P1754.4A) for all active duty personnel and Reservists.The primary objective of the EFMP is to ensure that sponsors are assigned to locations where services exist to support their Exceptional Family Member (EFM).
Exceptional Family Member Program Coordinator:: A designated individual at the local Marine & Family Services Center who provides information and assistance to Marine & Family Services' staff, local commands, sponsors and other family members regarding enrollment procedures, program benefits, available resources and facilities.
Major Medical Area:: Any area served by medical departments of the Armed Services or civilian medical treatment facilities, which have physicians capable of treating or monitoring family members who have chronic or severe medical conditions.
Severely Disabled:: A family member who has a serious medical condition that is expected to persist over a long time period and requires medical specialists, frequent hospitalizations, or intensive nursing care, pharmacy or laboratory support; or who requires frequent health services not available at most Naval Branch Clinics. Some examples of these conditions include: multiple disabilities, serious emotional disturbances, severe birth defects, and conditions requiring placement in residential care facilities.
Special Edition:: Educational needs of a physically or learning disabled child which are defined in an Individual Education Program (IEP) or Individual Family Service Plan (IFSP) that includes classroom placement that best meets the child's needs.

Accessible Housing:

An accessible house is a house that is built/adapted and is in compliance with the Americans with Disabilities Act (ADA), the Architectural Barriers Act and the Unformed Federal Accessibility Standards. Typically, ADA compliant housing (both Military and PPV) is provided to Marines who have family members who have physical disabilities and require wheelchair accessible ramps, countertops, showers and widened entry ways.

Corpsmen:

Corpsmen assigned to Marine Corps units also may have family member who have special needs and should also be enrolled in the Exceptional Family Member Program. Corpsmen who need to enroll should contact the installation Marine Corps EFMP Coordinator. The Marine Corps and the Navy use the same DD2792 forms. Leaders should ensure that their Corpsmen also have a Family Care Plan and that they communicate regularly regarding support issues and their personal family readiness.

DD2792 Forms:

The required forms for enrollment in the EFMP are:

DD Form 2792, Exceptional Family Member Medical Summary for medical issues only, and
DD Form 2792-1, Exceptional Family Member Special Education/Early Intervention Summary for educational issues. Any Marine who has a child who has an Individualized Education Program (IEP) is required to enroll in the EFMP.

Eligibility Criteria:

An exceptional family member is defined as an authorized family member (spouse, child, stepchild, adopted child, foster child, or a dependent parent) residing with the sponsor who may require special medical and/or educational services based upon a diagnosed physical, intellectual or emotional handicap such as Asthma, Cerebral Palsy, Mental Retardation, Dyslexia, ADD, ADHD, Autism, Oppositional Defiant Disorder, or Depression. Disabilities may range from mild to severe.

Enrolling in the Exceptional Family Member Program (EFMP):

The Marine should ensure his/her family member is enrolled in DEERS, and; Contact the assigned EFMP Coordinator at Marine and Family Services (MFS) Center who will assist them in obtaining medical and educational evaluations, and provide the necessary forms for the Marine, the medical provider, and, if necessary, the child's school official to complete; Return the completed forms to the EFMP Coordinator who will forward them to the Central Screening committee and to Headquarters Marine Corps for processing and category assignment.

Exceptional Family Member (EFM):

An Exceptional Family Member (EFM) is defined as an authorized family member (spouse, child, stepchild, adopted child, foster child, or a dependent parent) residing with the sponsor who may require special medical and/or educational services based upon a diagnosed physical, intellectual or emotional handicap such as Asthma, Cerebral Palsy, Mental Retardation, Dyslexia, ADD, ADHD, Autism, Oppositional Defiant Disorder, or Depression. Disabilities may range from mild to severe.

Exceptional Family Member Program (EFMP):

The Exception Family Member Program is a mandatory enrollment program (MCO P1754.4A) for all active duty personnel and is designed to provide assistance to active duty personnel with family member(s) who have special needs before, during and after relocation due to Permanent Change of Station (PCS) Orders.

Exceptional Family Member Program Coordinator:

Each Marine Corps base has an assigned EFMP Coordinator located at the Marine and Family Services (MFS) Center. Coordinators can assist Marines and their family members with completing the DD2792 and also provide information and referral services, local, State and Federal resources. For more information regarding EFMP Coordinators click here.

Exceptional Family Member Program Literature:

Installation EFMP Coordinators have program literature such brochures available for distribution.

Family Care Plan:

A Family Care Plan is a working plan that provides caregivers guidance in the event of the active duty members absence. Active duty personnel who are single parents and those who have Exceptional Family Members (EFM) should have ongoing Family Care Plan that is continually reviewed and revised as needed. The plan should provide detailed information such as legal authorizations, medications, emergency contacts, physicians, teachers, therapists and other points of contact who would help care for your special family member and address other responsibilities the Marine may have etc.

Financial Cost and Impact:

When a Marine is overseas on an accompanied assignment and his family member has to be returned to CONUS because of a diagnosed medical need that they did not report during Suitability Screening and cannot return to the overseas assignment because medical providers are not available. The cost for relocating the family members, travel, household goods shipping etc. is expensive and could have been avoided. Additionally, if the Marine also has to return to CONUS then it affects Marine Corps manpower because then another Marine will have to be located to replace the Marine returning to CONUS.

Home Medical Care:

Please see Home-health Agency

Home-Health Agency:

A home-health agency is an interdisciplinary healthcare team that provides support to home-bound family members with significant medical needs. The physician develops a Plan of Care and the home health agency staff communicates with the physician on a regular basis. If it is the child who is receiving visits from a home health agency then usually the Spouse is the primary caregiver and both parents should seek respite care when needed. When it is the spouse receiving home health agency support then the Marine is typically the primary caregiver unless an immediate family member is available to support the spouse 24/7. These Marines should have a Family Care Plan, should be enrolled in the EFMP and, as a leader, you should be querying him regularly about his/her family readiness.

Hospice Care:

Hospice care is provided to family members who have a limited life expectancy and have made the decision to spend their last months at home or similar setting and involves a team-oriented approach to medical care, pain management, and emotional and spiritual support expressly tailored to the patient's needs and wishes. Although most hospice patients are cancer patients, hospices accept anyone regardless of age or type of illness. Hospice care is a Tricare covered benefit. Typically, a family member serves as the primary caregiver and, when appropriate, helps make decisions for the terminally ill individual. Members of the hospice staff make regular visits to assess the patient and provide additional care or other services. Hospice staff is on-call 24 hours a day, seven days a week. The hospice team develops a care plan that meets each patient's individual needs for pain management and symptom control. The team usually consists of:

The patient' s personal physician;
Hospice physician (or medical director);
Nurses and/or Home health aides;
Social workers;
Clergy or other counselors;
Trained volunteers; and
Speech, physical, and occupational therapists, if needed.

In-Home Medical Support:

Please see Home-health Agency

Inclusive Child Care:

Most children with disabilities are easily served in a standard child care setting with little or no accommodations. However, some children require extra support to ensure the environment is safe for the child. Attention needs to be given to the environment, staff support, medical needs of the child, the strengths of the child so that he/she can participate in the daily routines and activities of the class regardless of his/her disability.

Individual Education Program (IEP):

Per the Individuals with Disabilities Education Act, each public school child who receives special education and related services (i.e. occupational, speech and physical therapy, transportation) must have an Individualized Education Program (IEP). An IEP describes the special education and related services specifically designed to meet the unique needs of a student with a disability. The program is developed at one or more IEP meetings, and its provisions are detailed in writing in the IEP.

It is customary for both parents to attend an IEP meeting but not necessary. Its important that both parents understand and agree upon the special education needs of their child. IEP meetings can be very stressful for parents because sometimes there are disagreements over what services, goals and objectives are more appropriate for the child. If the Marine cant attend then its a good idea for the spouse to take a friend or advocate with them to support them through the IEP team meeting. Usually IEP meetings are an annual occurrence, however, when interim changes are required the IEP team has to meet to make changes to the IEP.

Individual Family Service Plan (IFSP):

An Individual Family Service Plan is a written plan for early intervention services, developed by a Early Intervention Program Service Coordinator and the family, that identifies individualized supports and services that will enhance a identified special needs child development through birth to age 3.

Limits of Confidentiality and Privacy:

See Privacy Act of 1974.

Marine Corps Community Services (MCCS):

Enhances unit and family readiness by delivering programs such as Marine Corps Family Team Building (MCFTB), Military One Source Information and Referral Service, Counseling Services and New Parent Support. The programs are designed specifically for Marines and families to increase their awareness of relevant readiness issues, while offering creative ideas to build a healthy family. Through proactive education, training, coordination of support services, materials and tools, MCCS promotes personal and family readiness that can be applied in everyday situations. Military One Source is also able to coordinate counseling services for Marines and families in need of counseling support to help cope with deployment related issues, reunion concerns, parenting, childcare and other everyday issues. Marines and family members are allowed six face-to-face counseling sessions per incident with a civilian mental health practitioner for free. A Marine or family member will call a One Source consultant who will determine if there are on base resources readily available to assist the caller. If on base resources are not available, the One Source consultant will provide the caller an immediate referral to counseling assistance, and using their nationwide network of providers, will find a licensed mental health practitioner near the caller. Utilizing Military One Source is ideal for Marines and Marine Reservists (and families) needing counseling services but who are not located near an installation. Marine and Family Services (MFS) counseling is available to those units and families in need of counseling support in the areas of combat stress, stress reduction, anger management, new parent support, and couples counseling.

Marine Corps Total Force System (MCTFS):

Continuously records, processes, and maintains personnel and pay data for all active, reserve, and retired personnel. Click here for more information including a complete list of information tracked.

Marine and Family Services (MFS) Center:

The EFMP Coordinators are located at the MFSCs. MFSCs also offers a wide variety of counseling services for families who may need some help in coping with the emotional side or caring for a family member with special needs. The MFSCs also have financial counselors who can assist families who need help achieving their financial goals or when they need guidance when problems arise. Click here for more details.

Medical Bills:

Ultimately there are many reasons why a Marine may have received a medical bill. Medical bills are often received when a family member receives a referral from their Primary Care Manager (PCM) to seek specialty care from a provider. If the provider provides additional services/care that are not authorized on the referral, the family member may be billed by the provider because TRICARE may not pay for unauthorized services/care. These Marines should seek assistance from the Debt Collections Assistance Officer located at the Military Treatment Facility (MTF) to ensure they are not being billed erroneously and work closely with the TRICARE Service Center Beneficiary Counseling and Assistance Coordinators (BCACs) to learn how to utilize the TRICARE network.

Military OneSource:

The services of Military OneSource supplement the existing support system for Marines and their families by providing assistance 24 hours a day, 7 days a week via toll free telephone and Internet access. In addition, Military OneSource supports geographically dispersed Marines and their families (recruiters, Inspector and Instructor staffs, and mobilized reservists) who do not have traditional services available. Resources are available on topics to include parenting and childcare issues, education services, financial information and counseling, legal, elder care, health and wellness, crisis support and relocation. Marines or family members seeking assistance can call 800-342-9647. Military OneSource Online can be visited at www.militaryonesource.com.

Official Counseling:

Official Counseling usually requires a page 11 entry in a Marine's SRB when they fail to enroll in the EFMP after receiving an order to enroll. Official counseling for failing to enroll in the EFMP is a rare occurrence.

Overseas Screening Requirements:

The purpose of an Overseas Screening (OSS) is to identify medical, dental, educational and potential duty limiting conditions or requirements of both service and family members. Completing a screening will ensure that both the family and service member are qualified for overseas, operational duty, and remote duty assignments. For more information regarding Overseas Screening please click here.

Pre-existing Condition:

It has been common practice for medical insurance carriers to deny or charge considerably more for coverage for pre-existing medical conditions on applications for new policies. This is an issue for Marines who separate from the Marine Corps who have family members with diagnosed life-long conditions. Typically retirees chose to retain their TRICARE coverage, however, Marines being discharged should be aware of insurance companies with pre-existing condition policies. For more information please see: http://www.hep-c-alert.org/links/hippa.html

Privacy Act of 1974:

The Privacy Act of 1974, 5 U.S.C. § 552a (2000), is characterized as an omnibus "code of fair information practices" that attempts to regulate the collection, maintenance, use, and dissemination of personal information by federal executive branch agencies. No agency shall disclose any record which is contained in a system of records by any means of communication to any person, or to another agency, except pursuant to a written request by, or with the prior written consent of, the individual to whom the record pertains. This means that EFMP Coordinators are not permitted to share any medical information about a family member without prior written consent from that family member. Certain types of communication are consented to when filling out the EFMP forms.

Respite Care:

Respite care is short-term temporary care provided to people with disabilities in order that their primary caregivers can take a break from the rigors of supporting a family member with disabilities. Respite care can be for a few hours or provided overnight. Currently TRICARE Prime and the Program For Persons with Disabilities (PFPWD) does not provide respite care services but will be providing respite services to eligible Extended Care Health Option beneficiaries when the program implements sometime in FY06. When Marines are securing respite care services from an agency they should ensure criminal background checks have been completed on respite providers and should ensure the provider has the proper credentials to care for their family member if they have medical needs.

Safety and Support Response Plan:

A safety and support response plan is the common sense approach to emergency preparedness when you have a special needs family member who relies on power to use any medical equipment. These families need to consider having a generator readily available in the event of power loss. Some installations have established processes for family members residing in base housing to receive generators in the event of an extended power loss. In the event of an evacuation there should be a plan that details pharmaceutical needs, transportation, funding, lodging, medical equipment and medical supplies, emergency contacts etc. The installation EFMP Coordinator can assist families in their development of their own personal safety and support response plan.

Service Record Book (SRB)/Officer's Qualification Record (OQR):

These records are used for four primary purposes:

To record significant events, duties, awards and other pertinent information in a Marine's career for historical purposes.
To assist local or immediate commanders in making decisions concerning assignments, promotions, eligibility for schooling or overseas duty.
To maintain the original documentation for underlying entries into the manpower management system computer database.
To protect the privacy of individual Marines by consolidating information and limiting access to this information to personnel in the chain of command.

Special Education Meetings:

See Individualized Education Program

Suitability Screening:

See Overseas Screening Requirements