by Randolph T. Holhut
American Reporter Correspondent
August 24, 2009
WHEN WILL OBAMA START FIGHTING FOR REAL HEALTH CARE REFORM?
THE NETHERLANDS, Aug. 23, 2009 -- I am currently assigned to a small NATO base in the Tri-Border Area of Europe, where Belgium, The Netherland and Germany meet. It is tiny compared to other installations I've worked at. The airfield is home to AWACS (Airborne Warning and Control Systems) E3 Century planes that are serviced and flown here by 3000 people from 16 countries. The American presence of 550 personnel is just a slice of the pie that makes up the larger group. Those stationed here are high-ranking enlisted men and women and officers.
The AWACS are extraordinary planes with super- duper radar. They are considered the premier warning and control planes in the world. Made by Boeing, the AWAC is a souped-up 707/320. It can fly eight hours without refueling, is considered jam-resistant and can survive better than fixed radar in a war. They are expensive, large, funny-looking planes with 30-ft. rotating domes that can locate trouble within a 250 mile-plus range.
I enjoy going to the flight kitchen for lunch to see and hear some the people from the countries represented. The hats, uniforms and badges worn by the militaries are ornate and varied. It's interesting to wait in line and see the Italian sergeant talking to the Canadian pilot, joined by the American chaplain. It's a mini United Nations, with many languages, foods and customs being expressed.
The base's international library offers books, CDs and DVDs in 6 languages. The international pre-school facility provides a British-style nursery school curriculum to children from all over the globe. Those who staff the restaurants and stores on the base need to speak several languages to converse with various people who frequent their workplace. Today, I watched a clerk at the convenience store easily communicate with the French woman ahead of me, as well as myself in English and the German fellow behind me - and she was Dutch!
Some of the services offered on the base are exceptional. My favorite spot is the outdoor swimming pool. I arrive there at 6 p.m. and most days, have the place to myself until 7. The woman who runs the pool is thrilled to have a customer at the end of the day. She looks like the German swim instructor I had at Bayside High School, only this woman smiles a whole lot more. I enjoy unwinding in the well-kept pool, surrounded by huge pine trees. It feels great to stretch and breathe deeply through swimming after the long, hot, noisy days of being with children who have special needs.
There are only 33 children at the child development center and 22 at the after-school center that I am responsible for. I'm delighted that I will get to know all the children and staff by name and actually spend huge chunks of time with each one.
One Friday afternoon I debriefed with the director about my impressions made during the first week. As I sat with her, I remembered when I was a director of a migrant day care center in Goshen N.Y. I was about the same age she is now. Having studied child development but not knowing much about child psychology at the time, I was puzzled by the more aggressive or withdrawn children. Knowing that I needed some support, I made a visit to the local mental health clinic to see if I could convince one of the psychologists or social workers there to volunteer a few hours a month at our center. I wanted someone to observe several of the children and give me some tips about how to help them manage their feelings.
As a result of my request, a woman in her 60's came over once a week to teach the staff and myself about the psychological needs of the children and families. I learned an enormous amount from her, and the children were served well by her knowledge, warmth, experience and input. She was instrumental in my decision to become a child therapist.
Now I'm the 60-year-old lady, doing pretty much the same thing for young child-care workers that was done for my staff and me almost 40 years ago. The director of the children programs is jazzed about working with children and parents and is hungry to learn as much as she can to serve them. I just love it when life presents these full circle events and this time I have a chance to give back.
I was curious about her child development philosophy and her points of view about the needs of military children. She believes that many military children are handicapped in the real world because people don't always hold them accountable. She feels adults often pity children when one of their parents are gone for a long deployment or training. It is her thought that because of their sympathy, many children don't learn to tolerate frustration, nor how to make and keep friends, or find something constructive to do instead of plugged-in entertainment.
When I worked with children who were hospitalized, a similar dynamic happened for some of the pediatric patients. A few adults were hesitant to teach self-discipline skills, or give similar rewards and punishments that they used with healthy kids. Because of their illnesses they were often excused from the consequences of their problem behaviors. New studies show military children are 250 percent more likely to require mental health care than non-military families. Many times these children became demanding, spoiled or unable to cope with change and stress. The more that people gave into them, the weaker they became in their ability to regulate their emotions, learn important social skills, or find creative things to do when they were bored. I could understand what the director of the childcare center was trying to say, but I don't think it's the entire picture. I believe so much of the suffering of the children that I see on the bases is the result of being poorly or anxiously attached to their parents.
Juxtaposed with the director's thoughts on the well-being of the children in her care was information I gained from a fellow consultant that reported Pentagon figures showing twice the number of children are receiving mental health care than did so before the Iraq war. There is also an alarming spike in children who need mental health hospitalization. The spike coincided with the surge of thousand of troops into Iraq. I wonder if the increase is due to the accumulated effect of eight years of war and multiple deployments during the child's most formative years - years when bonding is paramount to healthy emotional, social and physical development.
Besides the deployment of a parent, the additional strains of war, such as the injury or death of a loved one and the added stress of moving every three years, have stretched 2,000,000 children to their limits. The added effects of child neglect, domestic violence, parental drug and alcohol abuse, homelessness, parental depression, traumatic brain injury and post-traumatic stress disorder are putting a huge burden on these young children. They are suffering depression, anxiety, and attachment disorders, or show signs of them.
At the same time, their families are having difficulty accessing mental health care in a timely manner because of non-existent permanent child mental health services on the bases, and lack of child and family providers who work in the TriCare military insurance system off of bases.
Health Net, Humana and other large corporations manage TriCare. It is an enormous, complex and confusing system that includes providers, middlemen, deductibles, co-pays, and long waits on the phone that most people do not understand how to navigate. These entities often deny services after a limited number of sessions unless time-consuming reports are filled out. They ration care to make a profit! Even when progress reports are completed, many times an authorization to continue service is not given even though the professional giving the care knows that the child desperately needs further treatment.
Many mental health practioners do not want to be a provider for TriCare or many other inefficient and withholding insurance companies because of the huge amount of paperwork that the clinician must wade through, claims that there was a pre-existing condition, long waits for reauthorization in the middle of treatment, delays in payments, loss of confidentiality for the client, denied and "lost" claims, and other payment-stalling tactics. Over the last 15 years, insurance companies have created numerous roadblocks and wedges between the patient and her health care provider while increasing the cost of premiums by large percentages every year.
According to a June 18 statement to the Subcommittee on Defense of the Senate Appropriations Committee by Kelly Hruska of the National Military Family Association, "National provider shortages in the psychological health field, especially in child and adolescent psychology, are exacerbated in many cases by low TRICARE reimbursement rates, TRICARE rules, or military-unique geographic challenges - for example large populations in rural or traditionally underserved areas. Many psychological health providers are willing to see military beneficiaries on a voluntary status. However, these providers often tell us they will not participate in TRICARE because of what they believe are time-consuming requirements and low reimbursement rates."
As a private practioner, I got tired of chasing after money owed to me from "health" insurance and mismanaged care companies. I stopped accepting them because I was spending more time collecting for services I provided than providing the services in the first place!
My new job as a child and family consultant to the military is to provide short-term counseling and to act as a referral source. But, often times I don't have anyone to whom I can refer a child or family. There is a shortage of child psychiatrists and child therapists; many times people can't access experienced professionals even if they have the best insurance. Many of my colleagues have left the field because of the interference of insurance companies in their professional lives.
I am very concerned that we are failing our nation's children. I'm angry when I think about the long-term effects of untreated mental health problems of military children and their families. As of 2009, according to the California Community Foundation, there have been 1.8 million U.S. troops deployed to Iraq and Afghanistan, resulting in thousand and thousands of psychological casualties. Many children are not properly protected from hurt and suffering; some are dying. It is a public health emergency that will have negative ramifications for generations to come. It is an outrageous state of affairs!
Lets do the right thing for all of us and work for real health care reform now! And while we are at it, let's really protect these children and keep their mommies and daddies home with them instead of sending them off to war again and again.
J.M. Sylvan holds a Ph.D. in Early Childhood Development and is the co-author of several books on child psychology.