Tag: medical

Help for Military Families: Tips to Navigate Special Education Process in Washington State

Posted on by Nicol Walsh

For families new to Washington State, this article includes state-specific information about special education systems. PAVE wants to extend a warm welcome to your entire family and to let you know that we are ready to support you. If your family has moved here to fulfill a military role, we thank you for your service!  

The language of special education, school and support systems differ between States. Following is some basic information to help you navigate Washington systems.   

Brief overview 

  • The article provides state-specific information about special education and medical systems in Washington State. 
  • Children in Washington must begin attending school by age 8 and continue until age 18, with some special exceptions. Washington offers multiple pathways to graduation and requires a High School and Beyond Plan for all students. 
  • The Department of Children, Youth and Families (DCYF) administers the state early intervention services (EIS) program, called Early Services for Infants and Toddlers (ESIT) for infants and toddlers with disabilities or delays. 
  • Washington school districts must respond to special education evaluation requests within 25 school days and complete evaluations within 35 school days. IEPs must be implemented within 30 days of eligibility determination, with transition plans required by age 16. 
  • Welcome to Washington! 

Welcome to Washington!

Whether your family is newly stationed in Washington or returning after time away, we welcome you! Moving to a new state is a big change, and it can be confusing when programs and services are called different names than they were in your last location. We’re here to help you learn how Washington’s education and medical systems work, so you can find the right support for your child. 

This video shares key facts to help you get started in Washington with a child who has exceptional needs. 

The School System 

The State Education Agency (SEA) is the Office of Superintendent of Public Instruction (OSPI). Local Education Agencies (LEAs) are organized as 295 Districts that operate independently and include a school board governance structure. School boards are responsible to follow the Open Public Meetings Act. There are nine Educational Service Districts (ESDs) that partner with OSPI to provide services for school districts and communities and to help OSPI implement legislatively-supported education initiatives. 

Charter schools, as public schools, have the same responsibilities as all public and non-public entities when serving students with disabilities. This includes developing and implementing Individualized Education Programs (IEPs) or Section 504 Plans for eligible students.  

Washington has adopted the Interstate Compact on Educational Opportunity for Military Children (commonly known as “MIC3”), which addresses certain school transition issues for military children consistently, from State to State. Each Member State has a MIC3 State Commissioner to oversee compliance and coordinate with other commissioners as needed. Parents of military-connected children may contact their School Liaison or MIC3 State Commissioner directly for support with Compact-related issues. PAVE has prepared a MIC3 Step-by-Step Checklist to Resolve Issues with the Interstate Compact. 

Washington’s Purple Star Award Program recognizes school districts that go above and beyond to support military families. Districts with this award provide a webpage with resources, have a trained staff member to help, and make sure teachers understand school transition rules under the Interstate Compact. Families can look for the Purple Star designation when choosing schools—it’s a sign the district is committed to welcoming military-connected students. To see which districts have the award, visit OSPI’s Purple Star page. 

Washington’s compulsory attendance law requires that children begin attending school full-time at the age of 8 and continue attending regularly until the age of 18 (RCW 28A.225.010). A child must have turned 5 years old by August 31 to enroll in kindergarten, and 6 years old to enroll in first grade. Military-connected children who are covered by the provisions of MIC3 may continue kindergarten or first grade, despite the school’s age requirement, if they were already enrolled and attending at the sending school in their previous state. This PAVE article explains how MIC3 supports children in military families with enrollment-related issues. 

Washington has multiple Pathways to Graduation and requires a High School and Beyond Plan (a career and college exploration experience that students begin in seventh grade) for all students. Under MIC3, schools must place military children in courses and programs based on placement and assessments performed by the sending school. Schools and districts may waive course requirements for placement and/or graduation of military-connected children, if a child has met the sending school’s requirements for grade advancement, placement, or graduation. Learn more about how MIC3 protects academic progress toward graduation in this PAVE article. 

Early Learning Programs (ages 0-5) 

Families concerned about a child’s development can call the Family Health Hotline at 1-800-322-2588, with support in multiple languages, or complete a free developmental screening online at ParentHelp123. The Department of Children, Youth and Families (DCYF) administers the state early intervention services (EIS) program, called Early Services for Infants and Toddlers (ESIT). After evaluating a child for eligibility and developing a family-focused plan, ESIT provides services to help infants and toddlers with disabilities or delays to learn and catch up in their development. Planning for the child’s transition out of ESIT by their third birthday includes coordination with the local school district to evaluate the child for school-aged services and supports. PAVE’s toolkit for family caregivers of infants and toddlers, From Birth to Three, outlines the educational rights of children and families in early intervention services. 

The Early Childhood Education and Assistance Program (ECEAP) is Washington’s no-cost prekindergarten program, aimed at preparing 3- and 4-year-old children from families facing more significant challenges for success in school and life. Families with children aged 3 or 4 by August 31st may be eligible for ECEAP. Children are eligible for ECEAP and Head Start based on their age and family income. Up to 10 percent of ECEAP and Head Start children can be from families above the income limit if they have certain developmental factors or environmental factors such as homelessness, family violence, chemical dependency, foster care, or incarcerated parents. PAVE’s 3-5 Transition Toolkit includes more information and resources to support families of children with disabilities in this age range. 

Special Education Information (School age) 

Every student with a disability is protected from discrimination under Section 504 of the Rehabilitation Act of 1973, including each student with a 504 Plan and each student with an Individualized Education Program (IEP). OSPI provides fact sheets about Section 504 in multiple languages that describe the evaluation process and state requirements. Parents may contact the Section 504/Civil Rights compliance officer assigned to their student’s school district. 

Washington Administrative Code (WAC), implements the provisions of the Individuals with Disabilities Education Act (IDEA) in WAC Chapter 392-172A. Parents’ rights and responsibilities in special education, known as procedural safeguards, are described in a short handbook available for download in multiple languages on OSPI’s website. 

A child’s right to a timely evaluation and the school district’s responsibility to seek out and serve students with disabilities, referred to as Child Find, is described on OSPI’s website. A school district has 25 school days to respond to a referral/request for special education evaluation. Once a parent/caregiver signs consent to evaluate, the district has 35 school days to complete the evaluation. A parent can request an evaluation any time there are concerns about whether services match the student’s present levels of performance and support needs. PTI provides a sample letter for requesting evaluation. 

Areas of evaluation are associated with 14 eligibility categories. Developmental Delay is a category for children ages 0-9 years old. The category of Emotional/Behavior Disability is unique to Washington – it is known as Emotional Disturbance under IDEA. Washington law requires that schools screen children in kindergarten through second grade for signs of dyslexia and to provide reading support for those who need it. 

School districts must write and implement an IEP within 30 calendar days after eligibility is determined. Decisions about the provision of special education services are made by an IEP team, which includes parents and specific required staff members (WAC 392-172A-03095). 

For a student with an IEP, there must be a transition plan in place by the beginning of the year in which they turn 16 years of age, unless the IEP deems it appropriate to begin earlier. Students “age out” of special education when they graduate from high school with a diploma or at the end of the school year in which they turn 21 years of age. If the student’s birthday is after August 31 of the current school year, they may continue special education until the end of that school year.  

In 2019, the Washington State Legislature provided students with multiple pathways to graduation by passing House Bill (HB) 1599. PAVE provides an on-demand webinar on this topic: Life After High School: A Two-Part Training to Help Families and Young People Get Ready. 

OSPI offers both informal and formal dispute resolution processes. IEP facilitation is available at no cost through Sound Options Group as a voluntary and informal process where a neutral facilitator helps parents and schools resolve special education concerns collaboratively. Washington State Governor’s Office of the Education Ombuds (OEO) acts as a neutral guide to help parents and schools resolve disagreements about special education services, without providing legal advice or advocacy. OSPI provides three formal special education dispute resolution processes: mediation, special education community complaint, and due process hearing. 

In addition to educational resources, families often need healthcare support. Washington offers options that work alongside TRICARE benefits to meet your child’s needs. 

Medical Supports and Services 

Washington’s Medicaid, which includes the Children’s Health Insurance Program (CHiP), is called Apple Health. Applications are managed through the Health Care Authority (HCA), which oversees various Managed Care Organizations (MCOs) to provide health plan options. Open enrollment for Medicaid and Medicare starts on November 1st, 2025 and ends on January 15th, 2026. This is the annual opportunity to sign up, renew, or change coverage to best suit your family’s situation. Washington Health Plan Finder has step-by-step instructions for applying and navigators to help with the application process. Help is available for those who are having trouble navigating the health insurance landscape.  

Eligible dependents of military families can benefit from both TRICARE and Medicaid. When a military family member is dually enrolled in TRICARE and Medicaid, TRICARE is the primary payee and Medicaid covers remaining costs. When a service member leaves the military and TRICARE benefits change, Medicaid can provide services similar to those of TRICARE Extended Care Health Option (ECHO).  

TRICARE allows beneficiaries to make changes to their health coverage when a Qualifying Life Event (QLE) occurs, such as a move to a new city, region, or zip code. When a QLE happens, you generally have 90 days from the date of the move to update your enrollment. 

In addition to QLEs, TRICARE offers an annual open season for making changes to health coverage. Open season starts on the second Monday in November and ends on the second Monday in December each year. Any changes made during this period take effect January 1 of the following year. During open season, families can: 

  • Stay in their current plan – no action required. 
  • Enroll in a new plan. 
  • Switch between plans. 
  • Change enrollment type from individual to family coverage, or vice versa. 

PAVE provides more information about TRICARE’s basic plans, ECHO, and the Autism Care Demonstration in the TRICARE’s Big Three on-demand module. For this and more personalized learning at your own pace, check out our PAVE Learning Library.  

Learn More

PAVE offers downloadable toolkits filled with fact sheets, worksheets, sample letters, and practical tips to guide you through every stage of your child’s education and care. These resources are designed to make complex systems easier to understand and navigate. 

Celebrate your military child all year long with social stories, activities, and tools that help families stay connected and ease transitions. The PAVE article, Purple Up! Celebrating the Month of the Military Child, includes free downloads in the top five languages spoken in military households. 

Want to know what makes a military family “exceptional”? Explore PAVE’s two-part series on the Exceptional Family Member Program (EFMP) to learn how enrollment works and what supports are available to help your family thrive. 

STOMP (Specialized Training of Military Parents) workshops and webinars offer military families the opportunity to access valuable information and resources while fostering connections and knowledge-sharing to create a collaborative environment that strengthens partnerships between families and professionals. STOMP events are free to military-connected families from all branches of services, including all service statuses and all installations worldwide. 

Need personalized help? Military families can access one-on-one support, training, information, and resources through PAVE’s Get Support request form — wherever the military takes you! 

Expanding Your Child’s Horizons Through Adaptive Play

Posted on by Nicol Walsh

We have come to learn what an important job play has in the development of a child’s brain and social skill set. Play sets the foundation for learning in infants and toddlers. It fosters social interaction and social behaviors in toddlers and preschoolers, as well as imagination and complex thinking in older children, teenagers, and even adults. What does that mean if your child or youth experiences the world a little differently? Do they have a chronic medical condition that limits physical stamina or mobility? Do they have a neuro- or developmental disability that may add extra steps or time in learning, or have a different view of success? This is the wonderful world of Adaptive Play.  

A Brief Overview: 

  • Adaptive Play is important at all stages of development and supports all children. 
  • Play is important developmentally across the lifespan. 
  • Adaptive pieces and activities don’t need to be expensive.  
  • Even small changes can make a big difference to a child’s positive development. 

Adaptive Play refers to games and toys that cater to children with unique physical or mental abilities. Creative and adaptive ways to create games of pretend, build with blocks, and explore sensory experiences can engage and support children with developmental delays, physical challenges, visual or hearing impairments, or significant emotional/behavioral challenges. In hospitals, recovering children might be able to “step outside” that bed or room for a while to have some playful fun. At home, if you have a child or youth with complex medical needs, creating ways to “step outside” can be done with a supported swing, a small jumping trampoline, chairs and a sheet, having friends over to set up a puppet show, or doing a special scavenger hunt in the house or even on paper. Don’t let the fancy name intimidate you; Adaptive Play doesn’t have to be complicated or expensive. This article’s goal is to provide a few ideas and website links to help you get started. As the person who knows your child best, you may already be creating Adaptive Play opportunities for your child. 

By trying some of the ideas at home, you may also learn some tools and tricks that can be useful at daycare or school. In the same way, you may also hear from teachers or therapists about something your child really enjoys at school that you want to try at home.  

Some examples might be:  

  • You may find out that certain sensory toys are great distractors 
  • Playdough uplifts a mood or that a tub of play sand stimulates thinking and helps a child become centered 

Sharing these experiences often helps build relationships between parents or other caregivers, teachers, and therapists that may help parents speak up with concerns about their child’s progress or services. 

Adaptive Playtime might include: 

  • Modified toys, such as Duplos instead of Legos 
  • BIG crayons, pencils, paper 
  • Water playtime with bubbles 
  • A tub of sand, kidney beans, flax seeds, with a variety of scoopers or measuring cups 

Digging into a sensory tub full of something to scoop and pour can help if your child struggles with large and small muscle or motor movement. Picking things up, holding things steady, touching, and smelling the objects also helps with sensory development. Changing these out frequently with new sights, textures, and smells also helps build both those motor and sensory “muscles” by keeping things interesting and new.  

Homemade playdough is another great way to turn “work” into play. Playdough develops muscle movement, touch, sight, smell, and inspires the imagination. The Imagination Tree has a recipe for a non-toxic playdough. Your child can help you make it and can choose the colors and the smells! (My favorite was when I used pie spice as a scent.) 

Don’t be afraid to let play get messy. Fingerpainting is very messy, but it engages multiple senses: touch, sight, motor movement, and imagination. Using an old sheet or a large piece of cloth for the painting can add to the imaginative and creative ways your child can use their art (a tent, a cape). Provide as many opportunities as possible, with multiple options that allow them to choose their own path. That is the beauty of play. 

Lynn Shugars, a Speech-Language Pathologist specializing in assistive technologies, has published a list of Adaptive Play and Leisure activities online.  Here are her “rules:” 

  • It should be FUN! Don’t turn it into work, or it won’t be enjoyable. 
  • It should be MOTIVATING. (This is often different from what teachers and parents think the student might enjoy). 
  • Expose a child to many toys and activities to determine what they like. 
  • Change activities often, but repeating activities is beneficial and highly recommended. This fosters memory skills and allows students to anticipate activities. (Visual Bingo, sorting games) 
  • Choose manipulative toys and activities. (Blocks, Duplos, large beads and string) 

There are many websites, Facebook groups, and Pinterest pages dedicated to creating great play and learning spaces for children with challenges. Pathyways.org offers articles and videos about the importance of playtime. Another resource is a website called Growing Hands-on Kids. 

Don’t limit yourself to what you read online! Creating toys and activities from everyday items allows children to see those everyday things as fun and usable and stimulates imagination in play. Getting creative with your child will create a model for how to work with objects in the world to keep things interesting and inventive. Engaging your child in the process of creating adaptive toys and activities might even make it easier to take a trip—you’ll find that all kinds of things that are readily available and inexpensive can become the perfect toy! 

Go, explore, and stretch those creative muscles. It’s a whole new world of fun! 

Exceptional Family Member Program (EFMP), Part 2: How Does EFMP Benefit Military Families?

Posted on by Nicol Walsh
Download the EFMP Enrollment Checklist

A Brief Overview

  • This is part of a two-part series on this topic of the Exceptional Family Member Program (EFMP). This article continues from Part 1: What Makes a Military Family Exceptional?
  • EFMP consists of three parts that work together for identification and enrollment, assignment coordination, and family support.
  • An off-site centralized office within the branch of service determines eligibility for EFMP and level of need.
  • Enrollment should be updated when there is new medical or educational information, and at least every three years.
  • EFMP enrollment ensures the family member’s needs are considered in the assignment process, although the military requirements take priority.
  • EFMP Family Support provides nonmedical case management, information, resources, and support.
  • Beginning in 2023, eligible families may access 20-32 hours of EFMP respite care per month through their branch of service, depending on level of need and availability of services.
  • Get the most from EFMP by contacting the installation’s Family Support office for information, resources, and support.

Full Article

The Exceptional Family Member Program (EFMP) is a mandatory program for all branches of the U.S. Armed Forces that helps military dependents with special medical or educational needs. The Army, Navy, Air Force, Marine Corps, and Space Force each have an Exceptional Family Member Program (EFMP). The Coast Guard, which operates under the authority of the Department of Homeland Security, has a similar program called the Special Needs Program (SNP).

EFMP is made up of three parts that work together to provide:

  1. Identification and Enrollment
  2. Assignment Coordination
  3. Family Support

Identification and Enrollment 

This is the entry point for EFMP. When the service member turns in the enrollment forms, they are sent for processing to an off-site centralized office within the branch that will determine eligibility and the level of need. The decisions are made by medical document reviewers who do not meet or speak with the dependents. Upon completion, the servicemember will receive a letter of verification from the EFMP program for their branch of service.

The same office will determine eligibility for TRICARE’s Extended Care Health Option (ECHO) supplemental medical insurance plan.

EFMP enrollment should be updated anytime the family member has new medical or educational information, and at least every three years.

Assignment Coordination

Once a family member is enrolled in the program, personnel and medical departments coordinate future duty assignments with consideration of the family member’s medical or educational needs. Although the family member’s needs are considered in the assignment process, military requirements take priority for assignment decisions. Orders that accommodate the family member’s needs may include:

  • Accompanied assignment only to locations that have services and resources to support the family member’s medical or educational needs.
  • Unaccompanied assignment, in which the servicemember relocates to the new duty station without the dependents, for a shorter duration than standard duty rotations.

If a service member disagrees with the availability or lack of availability of services at their next duty station, Department of Defense (DoD) Instruction 1315.19 (issued June 2023) provides them up to 14 calendar days from the date of the original assignment notification to request a second review and submit updated medical or educational information. A service being “available” does not mean the family won’t encounter a waiting list for these services, providers who are no longer taking clients or patients, or other interruptions in services.

Families enrolled in EFMP should ensure their paperwork is complete and current before assignment and permanent change of station (PCS) to a new duty station. Get ahead of assignment coordination and allow time for updates to be processed by updating the enrollment forms before the servicemember’s window opens for selecting orders.

Enrollment in EFMP does not prevent the service member from deploying or taking an assignment on unaccompanied orders.

Family Support

This is the department that directly serves families with nonmedical case management and support, including:

  • Information about local military and community programs, services, and supports.
  • Partnering with the School Liaison to provide information about early intervention services, special education, and school-based supports for students with disabilities.
  • Assistance with navigating DoD medical, educational, and counseling systems.
  • Local programs and activities for the benefit of families enrolled in EFMP, such as support groups, classes, and regional or installation events.
  • Warm handoffs to EFMP programs and School Liaisons at the next duty station.

Beginning in 2023, EFMP family support providers are required to personally contact each family assigned to their caseload and every family using the respective service’s respite care program at least once annually.

Find your EFMP enrollment or family support. In the drop-down menu for “Program or service”, select “EFMP Family Support” or “EFMP Enrollment”. Then, select your location from the drop-down menu labeled “Location based on”.

Respite Care

Eligibility requirements for EFMP respite care differ by branch of service and availability of services varies by location. The 2023 DoD Instruction 1315.19 standardized the respite care hours to 20-32 hours per month, across all branches of service, depending upon level of need of the eligible family member. It also extended coverage to include adult dependents and added the opportunity for eligible families to request additional services based on exceptional circumstances.

EFMP respite care is not an entitlement program, but a benefit available only to those who qualify. However, families who are ineligible for EFMP respite care may be able to access community-based respite care programs. EFMP respite care is also separate from TRICARE’s ECHO respite and ECHO Home Health Care (EHHC) respite programs, both with their own eligibility requirements.

Getting the most benefit from EFMP

Families enrolled in EFMP can get the most benefit from EFMP by contacting their installation’s Family Support office to:

  • Connect with the Family Support office at the new duty station to facilitate services and supports prior to a PCS
  • Locate resources at the state and local levels, such as civilian respite programs and disability-specific events
  • Identify state and federal benefits for which the enrolled family member may be eligible, such as Medicaid waivers, Vocational Rehabilitation, and scholarships for individuals with disabilities

The DoD developed the EFMP Family Support Feedback Tool as a method for families who have accessed their installation’s EFMP Family Support to provide feedback about their experiences. This information applies to the DoD’s Office of Special Needs’ policy development and program improvements for all branches of services.

Download the EFMP Enrollment Checklist.

Learn More about EFMP

This is part of a two-part series on this topic of the Exceptional Family Member Program (EFMP). This article continues from Part 1: What Makes a Military Family Exceptional?

STOMP (Specialized Training of Military Parents) provides information and resources to military families, individuals with disabilities, and both military and civilian professionals serving military families enrolled in EFMP. Register for upcoming STOMP workshops and webinars to learn more about the lifespan of benefits available to military families under federal law and military programs.

Military OneSource is an official DoD website and a information hub for all aspects of military life. EFMP & Me, a companion website managed by Military OneSource, organizes hands-on tools, federal and state information, military and civilian services and resources, and related supports and programs in one place.

Additional Resources

Exceptional Family Member Program (EFMP), Part 1: What Makes a Military Family Exceptional?

Posted on by Nicol Walsh
Download the EFMP Enrollment Checklist

A Brief Overview

  • This is part one of a two-part series on this topic of the Exceptional Family Member Program (EFMP). This article continues in Part 2: How Does EFMP Benefit Military Families?
  • Every branch of the U.S. Armed Forces is required to have a program for dependents of active-duty service members (ADSMs) with special medical or educational needs called the Exceptional Family Member Program (EFMP).
  • The Coast Guard is the only branch of service that uses a different name for their program – the Special Needs Program (SNP).
  • Enrollment is mandatory for all dependents of active-duty service members who have a special medical or educational need, regardless of the dependent’s age.
  • The two standardized enrollment forms are available on Military OneSource and, where available, on branch-specific websites.
  • Enrollment support is available on installation at family support centers.

Full Article

The Exceptional Family Member Program (EFMP) is a mandatory program for all branches of the U.S. Armed Forces that helps military dependents with special medical or educational needs. The Army, Navy, Air Force, Marine Corps, and Space Force each have an Exceptional Family Member Program (EFMP). The Coast Guard, which operates under the authority of the Department of Homeland Security, has a similar program called the Special Needs Program (SNP).

Purpose and Intent

The purpose of the EFMP is to –

  • identify dependents of servicemembers with special education or medical needs,
  • make sure the family’s needs are considered during the assignment process,
  • connect families with resources and assistance wherever they are assigned, and
  • assist with questions, concerns, and resources.

Although the purpose of EFMP and SNP are the same across all branches of service, there are some differences with names, procedures, and forms. There are also differences by installation, such as the availability of respite care providers and services provided by EFMP Family Support.

Eligibility

Enrollment in EFMP is mandatory for eligible dependents of active-duty service members (ASDMs). It is not an age-limited or age-specific program; dependent children and adults, including spouses, incapacitated adults (unmarried adult children with disabilities, parents and parents-in-law, and other adult dependents), must be enrolled in EFMP if they meet one of the following criteria:

  • Have special medical needs, including chronic and/or mental health conditions, that require ongoing treatment from medical specialists.
  • Have significant behavioral health concerns.
  • Are eligible for or receive early intervention services (EIS) through an Individualized Family Service Plan (IFSP) for infants and toddlers (ages 0-3).
  • Are eligible for or receive special education services through an Individualized Education Program (IEP) for students aged 3 through 21.

National Guard and Reserve personnel with family members who have special medical or educational needs may be eligible during the time period when the service member is called for active-duty orders under Title 10 (10 U.S.C.).

Enrollment

Enrollment in EFMP or SNP begins with two enrollment forms that are available for download from Military OneSource:

  • DD Form 2792, “Family Member Medical Summary”: This form must be completed by the family member’s TRICARE-authorized primary care provider. This can be either the primary care manager or a specialty care provider.
  • DD Form 2792-1, “Special Education/Early Intervention Summary”: The instructions state that the child’s IFSP or IEP must also be provided with this form. If the child has an IFSP, is not yet enrolled in school, or is home-schooled, the parents may complete and sign the fields reserved for the educational authority.

Medical providers often require a separate appointment for completing the EFMP paperwork. Ask about the provider’s policy for completing paperwork and how to submit the forms before the visit while scheduling the appointment. The family member’s TRICARE plan and how the provider bills the appointment will determine whether there will be a copay for the visit.

Although all branches of service use the same standardized forms, some of the services have developed website platforms for families to submit the forms electronically.

Save time in the future by keeping a copy of the completed enrollment forms and IFSP or IEP in your home records system. Never give away your last copy!

Help with Enrollment

If this is the first time the family has submitted the EFMP forms, it is a good idea to first take them to the branch-specific military and family support centers on installations for review, including:

Reserve components also have branch-specific military and family support centers.  Learn more about what these programs offer and links to the branch-specific Reserve programs in this article from Military OneSource.

Find your EFMP enrollment or family support. In the drop-down menu for “Program or service”, select “EFMP Family Support” or “EFMP Enrollment”. Then, select your location from the drop-down menu labeled “Location based on”.

Download the EFMP Enrollment Checklist

Learn More about EFMP

This is part of a two-part series on this topic of the Exceptional Family Member Program (EFMP). This article continues in Part 2: How Does EFMP Benefit Military Families?

Additional Resources

Related Services in School and Beyond can Support a Child’s Development and Learning

Posted on by Nicol Walsh

A Brief Overview

  • At school, related services help children with disabilities benefit from their special education by providing extra help and support. Options for related services are described in state law (WAC 392-172A-01155).
  • If a child with public health insurance needs specific therapies to meet medical needs, their insurance company is obligated to support those needs. Medical necessity is described in state law (WAC 182-500-0070).
  • Sometimes a service meets educational and medical needs. In those situations, the school might bill Medicaid directly, with parent permission. Families can learn more about School-Based Health Services (SBHS) and ask if their school is participating in this optional program.
  • Washington’s Office of Superintendent of Public Instruction (OSPI) issued guidance in August 2022 to clarify that all parts of a student’s IEP begin with the start of school unless an IEP team has agreed to shift something to meet a student-centered need. Schools may not delay the start of related services for their own reasons related to scheduling or resources.
  • For federal information about the range of options for related services provided by the school, see parentcenterhub.org.

Full Article

Children with disabilities have a range of needs that may be educational, medical, or both. As they grow, develop, and learn, those needs can shift. How family, school, and medical providers respond can impact how much progress the child makes in their emerging skills. This article includes information to help families understand how therapeutic services may be provided at school or elsewhere.

What are related services?

Schools call services that lie outside the scope of traditional teaching “related services.” Another term is “ancillary services.” Related services help children with disabilities benefit from their special education by providing extra help and support.

Therapies for disabilities that impact physical movement or speech are common. Transportation provided through the special education system also is a common related service. Less common in Washington State are in-school mental health services or counseling for behavioral health conditions. Various possibilities are listed in state law (WAC 392-172A-01155). Here are examples from the Washington Administrative Code (WAC):

  • Occupational, Physical, Speech Therapies
  • Counseling
  • Psychological Services
  • Behavioral Services
  • School Social Worker
  • Special Transportation
  • Parent Training

What does parent training mean?

Notice that the final option on this list is parent training. This service might mean the school helps parents understand the special needs of their child or something about their child’s development. Through the related service of parent training, the school can teach family members to help their child practice emerging skills when they’re at home.

Who provides a related service, and who pays?

A related service may be provided by any professional who is trained to assess and/or serve a specific need for a child with a disability condition that affects their learning or development.

When therapeutic services are paid for through medical insurance, they generally must meet a standard of being “medically necessary.” Keep reading for more information about therapeutic services available through the medical system.

Services are provided at school when they are determined to be “educationally necessary.” In those cases, the school district is responsible for payment.

Sometimes a service is both medically and educationally necessary. Sometimes schools seek parent consent to bill the student’s insurance to fund all or part of a related service. Washington State’s Health Care Authority (HCA) manages a program to reimburse schools for services provided to students who are eligible for Apple Health when those services are delivered as part of their Individualized Education Program (IEP).

Tip: See HCA’s website page about School-Based Health Services (SBHS) and consider asking your school if they are participating in this optional program. The guidebook includes information about allowable services. Note that Applied Behavior Analysis (ABA) therapy is explicitly excluded as a reimbursable service through the state’s SBHS program. Most other therapeutic options are reimbursable, including a range of mental health services.

A related service might be part of evaluation

Sometimes a related service is needed to assess a student because school staff do not have the expertise to properly understand a disability condition in order to make service recommendations. “Medical services for diagnostic or evaluation purposes” are written into federal law (IDEA Section 1432) as something an IEP can provide.

Keep in mind that special education evaluations must be comprehensive, in order to identify all of a child’s special education and related service needs, not just those that relate to the IEP eligibility category.

Families can seek an Independent Educational Evaluation (IEE) if they disagree with the methods or conclusions of a school district special education evaluation. PAVE provides an article and sample letter for requesting an IEE.

Related services support FAPE

The federal law that governs special education services is the Individuals with Disabilities Education Act (IDEA). The IDEA makes clear that its list of related services (see below) includes possibilities and options but does not include every related service a student might need. Other therapeutic services might be included in the IEP if they are educationally necessary.

Access and equity are protected by various educational and civil rights laws; anything that helps a student access school-related opportunities can be included as part of a student’s services. Extracurricular activities and school-sponsored sports count.

An IEP is a written commitment for the school to serve a student’s educational needs. Educational needs might be academic, social-emotional, or something else.  They might have to do with how the student functions or adapts to the environment of school.

Educational needs are determined through a comprehensive evaluation and a collaborative process that includes family, school staff, and anyone else with knowledge of the student and their disability-related needs. If an IEP team decides that a service is necessary for the student to access their right to a Free Appropriate Public Education (FAPE), then the school district is responsible to deliver those services.

IDEA does not expressly require that the IEP team include related services personnel. However, if a particular need or related service is discussed in an IEP meeting, it would be appropriate for the provider to attend. IDEA states that, at the discretion of the parent or the public agency, “other individuals who have knowledge or special expertise regarding the child, including related services personnel as appropriate” may be part of a child’s IEP team.

School-based related services might include, but are not limited to:

  • speech-language pathology and audiology services
  • interpreting services
  • psychological services
  • physical and occupational therapy
  • recreation, including therapeutic recreation
  • early identification and assessment of disabilities in children
  • counseling services, including rehabilitation counseling
  • orientation and mobility services for blindness/low vision
  • medical services for diagnostic or evaluation purposes
  • school health services and school nurse services
  • social work services in schools
  • parent counseling and training

The national Center for Parent Information and Resources (parentcenterhub.org) provides additional information about each of these possible related services and what they might look like for a student receiving them as part of an Individualized Education Program (IEP).

IEP services start on Day 1 unless the student needs something different

Washington’s Office of Superintendent of Public Instruction (OSPI) issued guidance in August 2022 to clarify that all parts of a student’s IEP begin with the start of school unless an IEP team has agreed to shift something to meet a student-centered need.

According to OSPI, “School districts are reminded that they cannot arbitrarily determine when special education and related services will begin or schedule them to begin after the start of the school year for some providers.”

OSPI’s guidance references a parent complaint and the state’s decision that schools cannot delay the start of certain services because of provider availability or district scheduling preferences. If it’s in the IEP, then the school is responsible to provide the service on all scheduled days that the student attends school. If services aren’t provided as scheduled by the IEP, then the IEP team can discuss how and when the student will receive compensatory services to make up the missed time.

Families have the right to file a complaint with the state if the school does not fully serve their student’s IEP. One option is the community complaint: PAVE provides a video describing that process. Another option is Due Process. The Procedural Safeguards describe all dispute resolution options that are free for families and protected rights under federal and state laws. 

Options for therapeutic services through the Medicaid system

If a child needs specific therapies to meet medical needs, their insurance company is obligated to support those needs. For children younger than 21 with Medicaid (Apple Health in Washington), medical necessity is determined through assessments that are a protected benefit called Early Screening and Periodic Screening, Diagnostic and Treatment (EPSDT). This screening process is overseen by the National Academy for State Health Policy (NASHP).

For help navigating complex medical issues, families can request case management from their insurance provider. Calling the number on your insurance card and asking if there a form for requesting case management is a way to begin. Sometimes a case manager is automatically assigned if claims become complex and expensive.

Medical criteria are different than school criteria. While school-based services are built to support a student’s educational access, EPSDT determinations are made to support safety and health in the home and community. Here are examples:

  • Physical Therapy (PT) at school might support adapted physical education (PE) or help the student navigate the school building or curriculum. Outside of school, PT can support navigating the home, community, recreational activities, and more.
  • Speech/language services at school are tailored to help the student achieve goals on their Individualized Education Program (IEP) or access their curriculum. Outside of school, speech/language services can expand to support communication for daily living and might be paired with Occupational Therapy (OT), for example, to work on feeding issues, sensory aversions, breathing challenges, alternative communication systems, and more.

Services to support access to school, home, and community might intertwine, and the school district might choose to bill Medicaid for reimbursement, with the family’s signed consent.

TIP: If the school is going to bill insurance, families may want to find out if the insurance company has a reimbursement limit for the service. If the child is getting a similar service in and out of school, care coordination is important to make sure all the services will be paid. Insurance may be willing to pay for more services if it’s clear which are for school-based needs and which are medical. Those details also may be important to note if services are denied and the family wants to appeal the denial through a medical or special education complaint option.

What meets the standard of medical necessity?

The Washington Administrative Code (WAC 182-500-0070) describes medical necessity. If a service is likely to prevent, diagnose, or treat an identified condition that is causing major life impacts, then it may meet the standard. The WAC says medical necessity is:

“…a term for describing requested service which is reasonably calculated to prevent, diagnose, correct, cure, alleviate or prevent worsening of conditions in the client that endanger life, or cause suffering or pain, or result in an illness or infirmity, or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction.”

The same WAC goes on to say that all federally funded insurance is obligated to pay for a service if it’s the most reasonable option available to serve the need. That standard is met when:

“There is no other equally effective, more conservative or substantially less costly course of treatment available or suitable for the client requesting the service.”

The same WAC also explains that a chosen course of treatment might mean a choice to track a condition through observation or offer no treatment. The WAC says:

“For the purposes of this section, ‘course of treatment’ may include mere observation or, where appropriate, no medical treatment at all.” 

A medical specialist, therapist, or pediatrician might assess the child to determine whether a specific service is medically necessary. In some situations, a case manager from the state’s Developmental Disabilities Administration (DDA) may make the determination.

What about private insurance?

Families with insurance through an employer or the healthcare exchange will need to ask their provider for specific information about what therapeutic services are covered. A company’s human resources department is another place to ask about coverages and whether there is a choice of health plan with more allowable options. School-based services may be the only option for some, as medical parity laws do not protect all possible therapeutic services.

Here are a places to get support in understanding your health plan and navigating access to services:

Insurance denials for employer-based plans can be appealed through:

PAVE’s Family to Family (F2F) Health Information Center provides additional information and resources through it’s website, Family Voices of Washington. Click Get Help at wapave.org to request individualized support.

Children’s Long-Term Inpatient Program (CLIP) Provides Residential Psychiatric Treatment

Posted on by Nicol Walsh

A Brief Overview

  • CLIP serves children ages 5-17 by providing mental-health treatment and school in a secure, residential facility. Read on for more information about CLIP eligibility and how to initiate a referral.
  • Young people placed in CLIP could not recover adequately with the most intensive outpatient services available, which in Washington are provided through Wraparound with Intensive Services (WISe).
  • Family caregivers of young people with intensive behavioral health needs can request support from A Common Voice, staffed by lead parent support specialists. Find their contact information on the Center of Parent Excellence (COPE) page of the Health Care Authority’s website.

Full Article

Families have few options to help a child with a psychiatric illness that makes in-home, community-based care unworkable. Local hospitals are designed to provide crisis care and generally do not keep a patient for mental health treatment and recovery beyond a few days or weeks. Sometimes those short hospitalizations are not long enough for lasting stability.

One choice for children 5-17 is the Children’s Long-Term Inpatient Program (CLIP), which provides intensive mental health services and school in a secure residential setting. A CLIP stay is usually about 6 months long. Eligibility for CLIP ends on the child’s 18th birthday.

Most CLIP referrals are for children with Medicaid—public health insurance, which is called Apple Health in Washington State. Families with private health insurance have access to CLIP but may be referred first to private facilities for long-term, inpatient care. Medicaid is the payer of last resort.

Who is Eligible for CLIP?

  • Youth ages 5 to 18
  • Legal residents of Washington State
  • Youth diagnosed with a severe psychiatric disorder
  • Youth at risk to themselves or others or gravely disabled due to a psychiatric condition
  • Youth who are not successfully treated through community-based mental health resources

Families are involved and children get school at CLIP

Parents/legal guardians engage with the treatment team while a child is at CLIP. The goal is to help the child stabilize and provide the family with skills and tools for a successful return to the home, school and community.

Children attend school while at CLIP. Teachers at the residential facility manage the student’s Individualized Education Program (IEP), or Section 504 plan, and help with transitions from and back into the student’s local school.

CLIP referrals may be voluntary or involuntary

Parents and legal guardians can refer children to CLIP. The first step is to know whether the referral is voluntary or involuntary. Parents can volunteer their children younger than 13 for residential treatment. Youth 13 and older must voluntarily go to CLIP unless they meet criteria for involuntary commitment.

The Revised Code of Washington (RCW 71.34.010) establishes that an adolescent 13-18 may be committed for up to 180 days of involuntary inpatient psychiatric treatment if commitment criteria are met. Residential placement at CLIP is one way to carry out a commitment order, which may be based on a standard of imminent threat (to self or others) or grave disability/severe psychiatric deterioration. Seattle Children’s Hospital provides a Guide to the Involuntary Treatment Act (ITA).

To refer a child or youth to CLIP for voluntary admission, the parent, legal guardian, or youth may get help by following a CLIP administration menu that starts with the name of the child’s heath plan. A child’s mental health provider or social worker also can support a CLIP application.

The family can request a hearing with a regional committee, which may then refer the case to the CLIP Administration for final approval. Sometimes a child is put on a waiting list for an available bed.

CLIP is a step up from WISe

Young people placed in CLIP have a record of being unable to access an appropriate level of care within their community. That usually means failure to recover with services from our state’s most intensive outpatient option for children and youth, which is Wraparound with Intensive Services (WISe).

The WISe program was begun as part of the settlement of a class-action lawsuit, TR v Dreyfus, in which a federal court found that Washington wasn’t providing adequate mental-health services to youth. WISe teams provide a wide range of therapies and supports with a goal to keep the young person out of the hospital.

Families engaged in WISe and/or CLIP services are encouraged to participate in their regional Family, Youth, and System Partner Roundtable (FYSPRT), which provides a place to share resources, solidarity, and feedback about the behavioral health system. See PAVE’s article: Families and Youth Have a Voice on Mental Health Matters Through FYSPRT.

Organize and prepare for a CLIP application process

Families need an organized set of medical and school paperwork to complete CLIP applications. Refer to PAVE’s article about document management for guidance about how to create a care notebook or other filing system for this and other purposes.

The regional CLIP committee includes care providers from managed care organizations and other agencies that may provide additional support and resources to the family, regardless of whether a CLIP referral is recommended. Generally, the committee determines that all community-care options have been exhausted before recommending a more restrictive placement through CLIP. The team will also make a recommendation based on whether the child is likely to benefit from the therapeutic program, which is mental health based and may not be a good fit for an individual with a severe form of developmental or intellectual disability.

Where is CLIP located?

The largest CLIP facility is the Child Study and Treatment Center (CSTC) in Lakewood, adjacent to Western State Hospital. CSTC provides about 60 beds in cottages that house children in groups by age and other factors. Additional options with fewer beds include:

  • Tacoma, The Pearl Street Center
  • Spokane, the Tamarack Center
  • Yakima, Two Rivers Landing

Further Resources

Washington’s Health Care Authority (HCA) has additional information about WISe, CLIP, early signs of psychosis, and Family Initiated Treatment (FIT).  If a person 15-40 is newly experiencing psychosis, Washington offers a wraparound-style program called New Journeys (website link includes access to a referral form).