Christmas Afar: Remembering those deployed during the holidays

xmas tree deployed

The holidays are upon us and for those of us at home this year, please enjoy it.

Over the years I’ve spent a lot of birthdays (ironically the same day as Festivus), Christmas and New Years days away from those I love.

When you are downrange, it can seem that the world has forgotten you. There are still locations where a Skype or a Facebook update isn’t as plentiful and even a phone call may not be in the cards. It’s lonely. Frankly, it sucks.

Even if those niceties are available, there is no substitute for being home. But those in this situation knew this was part of the deal when they raised their hand and swore an oath. The reality is what it is and you deal with it when it’s your turn to go.

To be fair, your deployed ‘family’ is in it with you and the DFAC staff will try their best to serve up as good a meal as possible. But still it’s not home.

I’ll share a memory from 18 years ago that re-emphasizes to me each year that even the smallest gestures can mean the most to someone who is serving overseas during the holidays. It comes in the form of an envelope I received from a commander I never met. I never expected anyone to think of me during this time, but a general officer though enough to send this Air Force senior airman a letter:

 
Dear Airman Sabula,
 
During this holiday season, we are especially thankful to you for the sacrifice you are making far from home. Please know that you and your family are in our thoughts and prayers.
 
In spite of the end of the Cold War, the world remains a dangerous place. We must continue to pay a price to ensure our precious freedom. Sometimes that price involves separation from family and friends and serving in remote locations. We have entrusted the best in the world to this task; we are very proud of you.
 
Your gift to us this season is freedom–we are in your debt. On behalf of the men and women in Twentieth Air Force, I extend the deepest gratitude for a tough job, well done.
 
Sincerely,
DONALD G. COOK, Major General, USAF

 

Hundreds of people likely received the same letter all over the world, but to me it simply served as a reminder that service was appreciated, that I was making a difference far from home without the luxuries we as Americans take for granted.

I framed this letter and proudly display it as a reminder to think of others, be a leader when no one is looking and that everyone is important in our mission.

Every one of us knows someone who is or has deployed. Make sure you take a moment to think of them during this time of the year and take the opportunity to remind them that what they’re doing is meaningful and appreciated. It means a lot.

 

 
 

DOD releases 2015 military pay, compensation rates

WASHINGTON (AFNS) — The Defense Department announced the 2015 military pay and compensation rates for service members Dec. 22, with most service members receiving a 1 percent increase in basic pay.

The new rates for basic pay, basic allowance for housing (BAH), basic allowance for subsistence (BAS), and the cost of living allowance (COLA) rates for the contiguous U.S. (CONUS) will take effect Jan. 1, 2015.

Basic pay for service members will increase 1 percent, except for general and flag officers who will not see an increase in 2015.

BAH rates for service members in 2015 will increase on average $17 per month, or 0.5 percent. Rates are calculated using median current market rent and average utilities (including electricity, heat, and water/sewer) for each pay grade, both with and without dependents. Two changes were made to BAH rate computations for 2015: renter’s insurance, which contributed an average of 1 percent to rates, was eliminated, and the fiscal year 2015 National Defense Authorization Act reduced housing rates on average 1 percent for service members.

However, individual rate protection for service members remains an integral part of the BAH program. Even if BAH rates decline – including through the elimination of renter’s insurance and the reduction in the calculated rate – a service member who maintains uninterrupted BAH eligibility in a given location will not see a rate decrease. This ensures that service members who have made long-term commitments in the form of a lease or contract are not penalized if local housing costs decrease.

Service members can calculate their BAH payment by using the BAH calculator.

The 2015 BAS rates for military members will increase by 2.9 percent over last year. The new rates are $367.92 per month for enlisted members and $253.38 per month for officers.

The annual adjustments to BAS — a monthly nontaxable cash payment to military members intended to be used to buy food — are linked to changes in food prices as measured by the annual change in the U.S. Department of Agriculture Cost of Food at Home Index. From the beginning of October 2013 through the end of September 2014, the index rose by 2.9 percent, forming the basis for the increased BAS rates.

The DOD also released its 2015 CONUS COLA rates. Roughly 12,000 members will see a decrease in their CONUS COLA payments, while some 7,000 members will see an increase or no change, and 4,000 members will no longer receive a CONUS COLA payment.

CONUS COLA is a taxable supplemental allowance designed to help offset higher prices in high-cost locations, and rates vary based on location, pay grade, years of service and dependent status. Rates can increase or decrease depending on the prices in a specific duty location compared to prices in an average CONUS location. Service members can calculate their allowance by using the CONUS COLA calculator.

(DoD News, Defense Media Activity)

Make Your Voice Heard in AMFAS Assessment

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Your friends at American Military Families Autism Support are asking that you take a few minutes to help sculpt the future of autism support for military families.

Many of you have used AMFAS resources at some point over the last six years and as an all-volunteer organization of military families, it’s important to assess what’s important to our families.

Though the end of the year, an AMFAS assessment survey is available. The intent is to gauge the current awareness and support delivered by the AMFAS project and to facilitate input on needs of the community.

To take the short survey, click here.

You can help bring awareness to this important opportunity by visiting the AMFAS 2015 Support Assessment event page on Facebook by clicking here. Please invite people to give additional opportunities for feedback.

The assessment is purposely simple, with a few open-ended questions to help frame where we should be headed as a grassroots organization and a larger military autism community.

We’ve run a periodic survey many times in the past, because this effort is about our families. The focus here is continuous improvement, with fresh ideas of the community at the center of where we put our energy.

Since beginning this project in 2008 AMFAS volunteers have devoted thousands of hours to provide news, information, community and support to our military families. Our team is made of the same families who benefit from this project, so it means a lot to hear your thoughts and ideas, good or bad.

If you hate what we are doing, we want to hear from you most. Please put it into context of what can be done better.

If you think we are great, we look forward to hearing about the things we should continue doing, but also ask that you look for where we can do a little better.

Either way, your feedback is important and will make for a better support effort as we key in to things that are priorities for you in 2015. Thank you and remember: together we can make a difference!

Words of Thanks on Thanksgiving

Thanksgiving_MRE_MAFor me, the fourth Thursday in November is a pretty special day for spending with family.

This Thanksgiving Day, I’ll take an opportunity today to reflect on the people who mean so much in my life.

First and foremost, it means the world to actually be home with family this year. But there are so many this year who can’t be. That’s the reality of being a military family.

Every American should enjoy this day to it’s fullest and reflect on the freedoms and opportunities they enjoy. Federal holidays are wonderful for recharging and relaxing. Imagine if every military member deployed in harm’s way had that option today.

When you’re deployed there is no holiday. There is no real downtime. The mission continues.

When you have turkey or whatever meal today, save a seat at the table for those who can’t be with their loved ones. Make a toast, have a drink for those who live under General Order 1 and cannot, enjoy the freedoms we’re allowed while they’re cramped up at some FOB or pulling 12-hour+ shifts today. They are with their deployed family, but it’s not home.

I’ve lived this reality several times, so one of the first things I think of is those who’ll be visiting the DFAC or even ponying up to a ‘delicious’ Meal Ready to-Eat feast. You aren’t forgotten.

My incredible wife and kids are at the center of my universe and spending time with them today is truly a gift; my greatest Thanksgiving ever.

I am thankful for the steadfast determination my wife has shown in the eight years since our son was diagnosed with Autism. She does not give up looking for ways to make our son overcome the many challenges that have been presented to him, which are numerous.

I am thankful for the open arms my family has received from the community we moved to this summer. It was a difficult move and warm neighbors made a real difference.

While I am not thankful for autism, I am thankful for the multitude of ways it has positively changed me as an individual, father and advocate for families.

I am thankful for most everyone I’ve met along this autism journey. You are the reason AMFAS is what it is.

I’m thankful for the people I’ve had the opportunity to work with over the last six years since I started the AMFAS project. So many of you have stepped forward at certain points in the project. If you are one of them, know that you have my gratitude and respect

I’m thankful for the families who keep inspiring me to continue with this project. So many of you have something to give to this project and my hope is that you’ll consider this in the future.

I’m thankful for my teammates along the way who have had patience as things have needed to go on the back burner or priorities were delayed by real world events. We don’t get paid, so everyone in this effort is giving of themselves to make things better for the community.

I’m thankful that there are people who will continue to drive me to improve on what we’ve built, as there is no room for complacency in support to families.

It’s vitally important to me to emphasize my thanks to all our community leaders in the local groups we’ve established the last four years. There are so many perspectives and types of people who are part of this grand experiment in how to support military families. They do this selflessly, without any compensation except for the gifts of knowing they are making a true difference for families in their communities.

Lastly, I’m profoundly thankful for every one of you who has joined our community of support. Thank you with all my heart, for together we cal make a difference!

Have a terrific day and think about the thankful events and those with you or not on this special day.

 

Thanks to our military veterans and their families

amfas update

Today is a day for the those who are the true one percent of our nation. We’re talking about those who have served in our U.S. Armed Forces. Whether one day or multiple decades, service of any duration to our country is noteworthy.

As we celebrate Veterans Day, Also known as Armistice Day or Remembrance Day worldwide, let us also remember our autism warriors around the world, on the battlefield, or the battlefields back home fighting for our children dealing with autism spectrum disorder. Continue reading

Campaign on Food Allergies Supports Trick-or-Treating

 

We’re closing in on Halloween and like many families dealing with autism and other special needs, the dreaded candy bag is back.

As a father who remembers the gluttony of pillowcases full of chocolate (largest bags we could take) as a child, it’s been a very hard transition to what my own kids are experiencing.

Shortly after our son was diagnosed, we ran a TRICARE-covered allergy panel. The result was a bit overwhelming: 44 food allergies and sensitivities.

Since that time, our family has experienced a plethora of dietary restrictions, from being GFCFSF+++++ to bean-counting numbers of the low oxylate diet. We’ve dealt with elimination of gluten, casein, soy, what seems like a million other foods and the non-food artificial colors or flavors. What we’ve faced would be enough to spook the most ardent parents of common-sense nutrition goals.

For many of our families certain foods may not cause life-threatening allergic reactions, but can trigger mild to extreme behavioral changes. An example of this would be our discovery years ago that anything with Red 40 caused our son to become aggressive with his brother.

The time and energy employed to find replacement candies and treats for the kids has been a lot of work. If only other houses were doing what we have to do, our roles as parents could be refocused on the experience and not the logistics of basically building the entire night ourselves.

Fortunately, there are many others in similar circumstances as ours.

This Halloween, the organization Food Allergy and Education or FARE has created a campaign to raise awareness of food allergies. It’s called the Teal Pumpkin Project. The color Teal represents food allergy awareness.

Our family has been struggling with the reality of what to hand-out Friday night. Typically I make a last-minute run by the BX, Commissary or grocery store on the way home, but this year we’re going to do things a bit different.

The campaign encourages families to provide some alternatives to traditional candy for trick-or-treaters, such as pencils, bookmarks or small toys. A listing of options is available on their website.

Part of the effort is painting a pumpkin teal and putting it out front of your door with a sign to let people know you have non-food treats available. If you have allergy-sensitive options to give out, please consider printing out the poster from FARE. You can download the PDF here.

Visit the Teal Pumpkin Project blog for more information and tips. You can also go to FARE’s Facebook page here.

TRICARE, DoD Officials Hold Roundtable With Stakeholders On ABA Policy

Seal-AOC

Over the last month, military families and service providers went through great lengths to contact their TRICARE officials, legislators, support organizations and the media regarding TRICARE’s new policy on Applied Behavioral Analysis therapy.

Their actions, caused by a lack of timely official information on impacts of implementing the new Comprehensive Autism Care Demonstration coverage and concerns of limited access to appropriate care for military children with autism, made Defense Health Agency officials take note.

As a short-term measure, Defense Department officials announced postponement of provider rate changes until April 20, 2015, while RAND Corp. completes an independent analysis of prevailing rates for the service.

On Oct. 15, senior leadership of DHA and DoD met for a roundtable discussion with stakeholders. The meeting included military autism parents, military healthcare providers and representatives of autism, military and professional organizations.

A summary of the main outcomes of that meeting follows. You can download the handouts from the meeting here. Please note that while this feedback was provided by DoD officials, it is advisable to wait for the official notification.

  • The new policy, which was announced in the Federal Registry in June, went into effect on July 25, 2014. The reason for the July 25 date is due to the statutory end date of the Pilot program to avoid that those beneficiaries would be dropped from coverage.
  • The new contracts that some providers have recently received do not have to be signed until Dec. 31, 2014 as is explained in the policy. DHA will send additional clarification to the contractors concerning this. Also note that the policy includes that exceptions can be made to extend a current authorization by the TRO Director to ensure that there is no lapse in coverage for a beneficiary.
  • Beneficiaries can but do not have to choose between the Sole Provider Model (BCBA only) and the Tiered Delivery Model (tutor model). They can choose to combine these models as is in accordance with the BACB Guidelines. The key is that everything should be part of one comprehensive treatment plan for that child supervised by 1 BCBA so that that BCBA can decide who needs to be on the team for that child, whether that’s a BT, a BCaBA or another BCBA. So collaboration with another BCBA is allowed as long as the supervising BCBA for that treatment plan remains the same. In addition the billing has to be done by 1 BCBA or by 1 ACSP.
  • The Registered Behavior Technician Certification regulation taken under consideration to ensure consistency between the TRICARE requirement regarding and the BACB Guidelines and the RBT Requirements.
  • The current rate reduction delay includes the BCaBA rates.
  • The BCaBA is allowed to supervise if so determined by the BCBA in charge of the treatment plan. The BCaBA has to be supervised at a min rate of one hour of supervision per month in line with BACB Guidelines. To bill for supervision by a BCaBA that can be done under the BCBA code for supervision as is done by other services.
  • The 5 percent supervision requirement of BTs in the TRICARE manual is derived from following the BACB recommended minimum of one hour of supervision for every 20 hours of direct services per child, which comes out to 5 percent.
  • Regarding the discharge criteria, treatment should be provided until the patient shows improvement or until the patient is dissatisfied with the treatment. It is meant to be case specific and therefor therapeutic determination will be made by the therapists. But there has to be the ability to evaluate, discharge or change the program when that is appropriate so there is a solid treatment. This is to ensure good quality of ABA therapy which has been a concern that previous focus groups brought to the table.
  • There is no two-year limit to therapy. That decision is left up to the clinicians. In addition, even if all parties involved including the beneficiary, the PCM and the therapist want to stop treatment this does not mean that the beneficiary can never go back into treatment if needed.
  • Financial constraints are never used as a crosscheck. How much something is going to cost does not drive what is best for patients. Being fiscally responsible however is different.
  • There has not been a change in cost shares. The specific cost share for NAD families for tutor services is unchanged from the previous Pilot Program. The intent of Demonstration Programs such as the Pilot Program and the new Autism Care Demonstration is to closely examine its data as well as the concerns of its stakeholders in order to make course corrections. Given that currently not much data is available from the Pilot Program and many concerns from stakeholders have been expressed regarding the math of the cost shares this will be taken under consideration.*
  • The specified domains of behavior, communication and social skills in the policy are meant only to map treatment and do not limit the skills ABA therapy can address but rather are as determined by the ABA therapist.

In addition the following concerns and comments were heard.

  • There was a concern regarding the required minimum age of 18 months for beneficiaries with reason that currently children can be diagnosed as early as 9 months.
  • The discharge criteria in the TRICARE manuals are not consistent with the BACB Guidelines.
  • There was a discussion regarding providing the treatment plan to the PCM in order for the PCM to better support their patients and families, especially those not familiar with ABA therapy, and to consult to see whether treatment is going as they expect and as is intended. One attendee expressed that such a system was already in place, in such that providers are already required to submit their treatment plan and updates to TRICARE every 6 months.
  • It was suggested to continue to have access to the data collected on the ABA benefit programs. However the concern was that any new data will not be comparable as TRICARE has already and will again change the marketplace by continuing to change regulations.
  • A suggestion was made to create the standard for ABA insurance coverage using the 6 years’ worth of data and the great ideas already available and with the help of these working groups instead of continuing further studies and data tracking.
  • A concern was brought up to look into that only a majority of military children with autism access ABA therapy.
  • It was expressed to reconsider the reimbursement cuts that are currently delayed as the outcomes of this would be devastating to families and providers.

While there are still questions remaining, this meeting was a great step in the right direction and further follow-up has already been provided by Autism Speaks to DHA.

The senior leadership at this meeting expressed a great deal of concern and care for their patients, our children with autism. Their intent of the TRICARE regulations for ABA was and is to ensure that appropriate care is given to our kids.

In cases where this did not get translated in policy, it was acknowledged and was promised to be considered for revision. DoD officials expressed a desire to reach out more broadly to its stakeholders and to improve its communication.

They plan to try to set up another roundtable meeting with providers within the next few weeks. In the mean time they intent to process the feedback, work on clarifications and improvements and send out updates as applicable.

Katja Kox-Fishe provided this report. For more information on changes to ABA, please visit the AMFAS ABA Ops Center at http://amfas.org/aba2014.

 

Latest Charts on TRICARE’s New ABA Program

In a continuing effort to bring families the latest updates, we are posting the latest version of the AMFAS overview chart of the Comprehensive Autism Care Demonstration and TRICARE’s finally-released chart on ABA benefits as well. You can click on each the enlarge the image. For more information on the changes to ABA for military families (including PDF versions of these charts) visit the AMFAS ABA Operations Center.

 

Tricare ABA Chart Oct2014

ABAChart

 

 

 

On Independence Day be mindful of sensory issues

Independence Day is one of my favorite holidays because it encompasses the spirit of America in exuding the freedoms we enjoy.

Unfortunately, some of our families will have a vastly different experience with the rockets’ red glare and bombs bursting in air.

Our family has been very sensory conscious over the years. But even with these considerations, I’ve come to understand my children’s experiences through one of my own.

Let me share a personal experience.

On Independence Day four years ago I realized that I might indeed have some form of PTSD from my experience in Afghanistan.

That night as I was laying down to go to bed, someone down the street decided to explode a very large firecracker; like an M80.

For the next seven hours I tried going back to sleep but just lye there, shaking, heart pounding and I couldn’t control it. I didn’t sleep that night and was really affected by it, though I kept rationalizing that it was nothing.

For so many veterans like myself, this is one of the realities of deploying to the AOR.  I was not at some remote FOB, I had not been directly shot at or earned my Combat Action Badge. But the loud boom and ground shaking does affect you.

Stressors of rocket attacks or car bombs stays with you, even when you bury it inside.

Now every time I think of fireworks or loud noises, I’m reminded of this experience. I’m not alone.

Growing up in Southern California, I had friends who had issues when an aftershock followed one of our earthquakes. It put them on-edge and some really had challenges coping.

These things make it more apparent that we should be sensitive to the impact some can have on this day.

Whether it’s the flushing of toilets, the shrill of an alarm or, yes, even the local fireworks display, for children with autism and other special needs, sudden loud noises are terrorizing and can leave traumatic sensory marks.

As we celebrate freedom and independence, please take a moment to have situational awareness and be mindful on how fireworks, music or other sounds can impact our special families, veterans and even animals.

If you have pets, remember that some of them have acutely sensitive hearing and fireworks can be painful. Please consider this and keep them inside if possible.

If you’re buying fireworks, consider avoiding the ones that make the loudest explosions and opt for ones that offer more color and less ‘bang.’

If you’re going to a fireworks display consider having some earbuds or headphones at the ready to help dampen the sounds

If attending a party or gathering with other people, talk with the host about any issues or get the itinerary of any loud events during that time.

As we celebrate our Independence let’s do it in a safe and enjoyable way for everyone.