oversight

Military Personnel: Prior GAO Work on DOD's Actions to Prevent and Respond to Sexual Assault in the Military

Published by the Government Accountability Office on 2012-03-30.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

United States Government Accountability Office
Washington, DC 20548



           March 30, 2012

           The Honorable Louise M. Slaughter
           Ranking Member
           Committee on Rules
           House of Representatives

           Subject: Military Personnel: Prior GAO Work on DOD’s Actions to Prevent and
                    Respond to Sexual Assault in the Military

           Dear Ms. Slaughter:

           Sexual assault is a crime that has a far-reaching negative impact on individuals,
           families, and communities. It also has additional implications for the military services
           because it undermines their core values, degrades mission readiness and esprit de
           corps, subverts strategic goodwill, and raises financial costs. Since 2004, following a
           series of high-profile sexual assault cases, Congress has taken steps to address this
           crime in the military, including passing legislation that directed the Secretary of
           Defense to develop a comprehensive policy for the Department of Defense (DOD)
           on the prevention of, and response to, sexual assaults involving members of the
           Armed Forces. 1 Among other things, the legislation required DOD to establish a
           standardized departmentwide definition of sexual assault and procedures for
           confidentially reporting sexual assault incidents.

           DOD established the Sexual Assault Prevention and Response (SAPR) program in
           2005 to promote prevention, encourage increased reporting of the crime, and
           improve response capabilities for victims. DOD has formally defined sexual assault
           as “intentional sexual contact, characterized by use of force, threats, intimidation,
           abuse of authority, or when the victim does not or cannot consent. Sexual assault
           includes rape, forcible sodomy (oral or anal sex), and other unwanted sexual contact
           that is aggravated, abusive, or wrongful (to include unwanted and inappropriate
           sexual contact), or attempts to commit these acts.” 2 DOD and the military services
           rely largely on Commanders and Sexual Assault Response Coordinators to
           implement SAPR programs at military installations, including the coordinating and
           reporting of sexual assault incidents. Other responders include victim advocates,
           military lawyers (known as judge advocates), medical and mental health providers,
           criminal investigative personnel, law enforcement personnel, and chaplains.
           1
            Pub. L. No. 108-375, § 577, 118 Stat. 1811, 1926-28 (2004).
           2
            Department of Defense Directive 6495.01, Sexual Assault Prevention and Response (SAPR)
           Program (Oct. 6, 2005). DOD released revisions to its Directive in January 2012.



                                                                          GAO-12-571R Military Personnel
In the Office of the Secretary of Defense (OSD), the Under Secretary of Defense for
Personnel and Readiness has the responsibility for developing the overall policy and
guidance for the department’s SAPR program. 3 Within the Office of the Under
Secretary of Defense for Personnel and Readiness, OSD’s Sexual Assault
Prevention and Response Office serves as the department’s single point of
responsibility for sexual assault policy matters and is responsible for, among other
things, providing guidance and technical support; developing programs, policies, and
training standards for the prevention, reporting, response, and program
accountability of sexual assaults involving servicemembers; and preparing the
department’s annual report to Congress on sexual assault in the military.
Additionally, the DOD Office of the Inspector General is charged with overseeing
criminal investigations of sexual assault conducted by the DOD components and
developing policy for DOD criminal investigative organizations. Finally, in addition to
overall DOD policy, each military service provides sexual assault-specific guidance,
as well as standard operating and reporting procedures for responding to alleged
sexual assault incidents.

While DOD strives to promote a culture free of sexual assault, these assaults still
occur. Those assaulted may seek treatment at military treatment facilities (MTFs),
where health care providers serve a critical role in addressing the physical and
mental trauma experienced by a victim. Since 2008, we have issued four reports to
help inform congressional deliberations on issues related to sexual assault in the
military. 4 Additionally, we testified three times before the Subcommittee on National
Security and Foreign Affairs, House Committee on Oversight and Government
Reform, on our findings. You asked us for information about treatment for victims at
MTFs.

In response to your request, we are providing information related to this topic based
on our prior work. This includes information on how cases of sexual assault are
reported, documented, and investigated; how servicemembers are trained on sexual
assault prevention and response; and the availability of health care for sexual
assault victims. We briefed your staff on the information contained in this
correspondence on December 9, 2011. As discussed with your staff at that time, we
agreed to issue this report, which formally transmits the updated briefing slides. (See
encl. I.)

To provide this information, we reviewed DOD’s policy and guidance on the
prevention of and response to sexual assault for information on the medical care

3
 This responsibility does not include responsibility for legal processes provided under the Uniform
Code of Military Justice and Manual for Courts-Martial that are assigned to the judge advocates
general of the military services and criminal investigative policy matters that are assigned to the DOD
Office of the Inspector General.
4
 See GAO, Military Personnel: The DOD and Coast Guard Academies Have Taken Steps to Address
Incidents of Sexual Harassment and Assault, but Greater Federal Oversight Is Needed, GAO-08-296
(Washington, D.C.: Jan. 17, 2008); Military Personnel: DOD’s and the Coast Guard’s Sexual Assault
Prevention and Response Programs Face Implementation and Oversight Challenges, GAO-08-924
(Washington, D.C.: Aug. 29, 2008); Military Personnel: Additional Actions Are Needed to Strengthen
DOD’s and the Coast Guard’s Sexual Assault Prevention and Response Programs, GAO-10-215
(Washington, D.C.: Feb. 3, 2010); and Military Justice: Oversight and Better Collaboration Needed for
Sexual Assault Investigations and Adjudications, GAO-11-579 (Washington, D.C.: June 22, 2011).



2                                                                  GAO-12-571R Military Personnel
provided to victims 5 as well as DOD’s annual report on sexual assault in the military
for fiscal year 2010 (the most recent year available at the time we did our work). 6 We
also reviewed our prior work on DOD’s actions to address sexual assault in the
military, which focused on DOD’s SAPR programs, as well as the resources it has
dedicated to the investigation and adjudication of sexual assault allegations. To
conduct our prior work, we interviewed senior officials in OSD and the DOD Office of
the Inspector General. Also, for each military service, we interviewed Sexual Assault
Response Coordinators, judge advocates, medical and mental health personnel,
criminal investigative personnel, law enforcement personnel, and chaplains. We
visited military installations representing all of the military services in the United
States and overseas to assess implementation of the sexual assault programs and
met with various military commanders, including company and field grade officers,
and senior enlisted servicemembers. In addition, we obtained the perspectives of
numerous servicemembers through confidential surveys and one-on-one, structured
interviews. 7 Prior to its publication, we shared a draft copy with and solicited
comments on this product from officials in OSD’s Sexual Assault Prevention and
Response Office. Officials provided us with technical comments, which have been
incorporated as appropriate.

We conducted the performance audits that we reference in this product from
February 2007 through June 2011 in accordance with generally accepted
government auditing standards. We developed this product from October 2011
through March 2012. Generally accepted government auditing standards require that
GAO plan and perform audits to obtain sufficient, appropriate evidence to provide a
reasonable basis for our findings and conclusions based on our audit objectives. We
believe that the evidence obtained provides a reasonable basis for our findings and
conclusions based on our audit objectives.

In summary, our work resulted in 25 recommendations on various aspects of the
SAPR program, and DOD concurred or partially concurred with all of our
recommendations. DOD has since begun or completed action on each of these
recommendations. To date, our analysis shows that DOD has fully implemented
13 recommendations and has partially implemented the remaining 12
recommendations, which we will continue to monitor.

Our previous work has included information about how cases of alleged sexual
assault in the military are reported, documented, and investigated.


5
 Department of Defense Directive 6495.01; Department of Defense Instruction 6495.02, Sexual
Assault Prevention and Response Program Procedures (June 23, 2006), as updated by subsequent
changes.
6
 Department of Defense, Fiscal Year 2010 Department of Defense Annual Report on Sexual Assault
in the Military (March 2011).
7
 Because we did not select survey and interview participants using a statistically representative
sampling method, our survey results and the comments provided during our interview sessions were
nongeneralizable and therefore cannot be projected across DOD, a service, or any single installation
we visited. However, the survey results and comments provided insight into the command climate
and implementation of sexual assault prevention and response programs at each location at the time
of our visit.



3                                                                GAO-12-571R Military Personnel
•    Reporting: The department has established two methods for reporting sexual
     assaults—unrestricted and restricted. Under the unrestricted reporting option, the
     chain of command is informed about the alleged sexual assault, and according to
     DOD, an investigation will be initiated. The restricted reporting option permits a
     victim to confidentially disclose an alleged sexual assault to select individuals
     and receive care without initiating an investigation.

•    Documenting: In February 2010, we reported 8 that DOD was not using a
     centralized, case-level database for documenting reported cases of sexual
     assault as required by a law enacted in 2008. 9 Accordingly, we made
     recommendations that DOD adhere to key system development and acquisition
     management processes and controls in developing its database, and DOD
     concurred with these recommendations. In a March 2011 status report to
     Congress, DOD indicated that it expected the database to be operational by
     August 2012 and noted that it will adhere to key standard information technology
     practices. 10

•    Investigating: We also reported that absent DOD-level guidance, the military
     services have developed and implemented their own guidance on sexual assault
     investigations and, in some cases, take different approaches to conducting their
     investigations. 11 In June 2011, we recommended that DOD develop and
     implement a policy that specified procedures for conducting sexual assault
     investigations and that the services leverage each other’s resources for
     investigating and adjudicating alleged sexual assault incidents. The department
     concurred with these recommendations and is taking actions to address both of
     them by drafting a sexual assault investigations policy that would be applicable to
     the services’ military criminal investigative organizations and by taking other
     steps to coordinate the expertise and resources of the services’ criminal
     investigative organizations.

Our previous work also included information about sexual assault prevention and
response training for servicemembers and investigators.

•    Servicemember training: We found that, although servicemembers received initial
     and annual refresher training on sexual assault prevention and response, the
     training was not consistently administered and had not been systematically
     evaluated for effectiveness by DOD. 12 Further, we reported that OSD found that a
     greater level of detail was needed in policy to guide the execution of the


8
GAO-10-215.
9
 The Duncan Hunter National Defense Authorization Act for Fiscal Year 2009, Pub. L. No. 110-417,
§ 563, 122 Stat. 4356, 4470-71 (2008).
10
 In technical comments on a draft of this report, officials in OSD’s Sexual Assault Prevention and
Response Office noted that they expect the database to be initially operational on March 30, 2012,
and fully operational by August 2012.
11
    GAO-11-579.
12
    GAO-08-924.



4                                                                GAO-12-571R Military Personnel
     department’s training requirements. 13 Accordingly, we recommended that DOD
     review and evaluate its sexual assault prevention and response training
     programs for greater effectiveness—a recommendation that DOD has
     implemented.

•    Investigator training: We also reported that the DOD Office of the Inspector
     General has not worked with the military services to assess the content or the
     effectiveness of the sexual assault training that is being provided to investigators
     and has not evaluated how many agents are currently meeting a minimum
     standard of competency. 14 In June 2011, we recommended that DOD develop
     and implement clear goals and objectives for monitoring and evaluating the
     services’ sexual assault investigations and related training. DOD also concurred
     with this recommendation and has begun evaluating the military criminal
     investigative organizations’ sexual assault investigation training.

Additionally, our previous work included information on mental health care as well as
other health care provided to servicemembers who are sexually assaulted.

•    Mental health care: We found that program officials, such as Sexual Assault
     Response Coordinators, generally took steps to ensure that servicemembers
     who are sexually assaulted are made aware of their options for seeking mental
     health care and are able to access it, if desired. 15 However, there are barriers
     that affect access to mental health care, including a DOD-reported shortage of
     mental health care providers and perceptions of stigma associated with seeking
     care. In August 2008, we recommended that DOD systematically evaluate and
     develop an action plan to address any factors that may prevent or discourage
     servicemembers from accessing mental health services following a sexual
     assault. DOD concurred with our recommendation and, in response, chartered
     the Health Affairs Sexual Assault Task Force, which made a number of
     recommendations intended to improve the availability of health care.

     Other health care: DOD’s Directive states that it is DOD policy to ensure victims
     of sexual assault receive timely access to appropriate treatment and services. 16
     Victims are entitled to a Sexual Assault Forensic Medical Exam, which may occur
     at a non-military facility under a memorandum of understanding, as well as
     treatment for sexually transmitted diseases and pregnancy, and an assessment
     for follow-up care.



13
    GAO-10-215.
14
    GAO-11-579.
15
    GAO-08-924.
16
  Department of Defense Directive 6495.01. In technical comments on a draft of this report, officials in
OSD’s Sexual Assault Prevention and Response Office noted that its recently revised Directive now
specifies that sexual assault patients shall be given priority and treated as emergency cases,
regardless of whether physical injuries are evident. Officials added that DOD has also adopted the
Department of Justice’s “National Protocol for Sexual Assault Medical Forensic Examinations” as its
standard for care of sexual assault victims.



5                                                                  GAO-12-571R Military Personnel
                                       –––––

As we agreed with your office, unless you publicly announce the contents of this
report earlier, we plan no further distribution until 30 days from the report date. At
that time, we will send copies of this report to the Secretary of Defense, appropriate
congressional committees, and other interested parties. In addition, the report is
available at no charge on GAO’s website at http://www.gao.gov.

If you or your staff have any additional questions, please contact Brenda S. Farrell at
(202) 512-3604 or farrellb@gao.gov or Randall B. Williamson at (202) 512-7114 or
williamsonr@gao.gov. Contact points for our Offices of Congressional Relations and
Public Affairs may be found on the last page of this report. Major contributors to this
report were Bonnie Anderson, Assistant Director; David E. Moser, Assistant Director;
Jennie F. Apter; Helen Desaulniers; Ashley R. Dixon; Erin Henderson;
Natalie Herzog; Wesley A. Johnson; Kim Mayo; Lisa Motley; Mario D. Ramsey;
and K. Nicole Willems.

Sincerely yours,




Brenda S. Farrell
Director, Defense Capabilities and Management




Randall B. Williamson
Director, Health Care
Enclosure – 1




6                                                       GAO-12-571R Military Personnel
Enclosure I




      GAO’s Review of DOD Actions to Prevent and
      Respond to Sexual Assaults in the Military

       Briefing for staff of Representative Slaughter
       Ranking Member, Committee on Rules
       House of Representatives

       Updated




                                                                         1




7                                                   GAO-12-571R Military Personnel
Enclosure I




      Overview


       •   Introduction
       •   Request Letter Questions
       •   Briefing Topics
       •   Scope and Methodology
       •   Background
       •   Findings from Our Previous Reports
       •   Recommendations from Our Previous Reports
       •   Our Previous Reports and Testimonies


                                                                   2




8                                              GAO-12-571R Military Personnel
Enclosure I




      Introduction

       • Following a series of high-profile sexual assault cases
         involving servicemembers, in 2004 Congress directed the
         Secretary of Defense to develop a comprehensive policy
         for the Department of Defense (DOD) on the prevention of
         and response to sexual assaults involving
         servicemembers. Among other things, the legislation
         required DOD to establish a standardized departmentwide
         definition of sexual assault and procedures for
         confidentially reporting sexual assault incidents.




                                                                     3




9                                                GAO-12-571R Military Personnel
Enclosure I




      Introduction (cont.)

       • DOD defines sexual assault as intentional sexual contact,
         characterized by use of force, threats, intimidation, abuse
         of authority, or when the victim does not or cannot
         consent.

       • Sexual assault includes rape, forcible sodomy (oral or anal
         sex), and other unwanted sexual contact that is
         aggravated, abusive, or wrongful (to include unwanted
         and inappropriate sexual contact), or attempts to commit
         these acts.


                                                                        4




10                                                  GAO-12-571R Military Personnel
Enclosure I




      Introduction (cont.)

       • Sexual assault is a crime that has a far-reaching negative
         impact on individuals, families, and communities and has
         additional implications for the military services because it
         undermines their core values, degrades mission readiness
         and esprit de corps, subverts strategic goodwill, and
         raises financial costs.

       • According to a Department of Defense Annual Report on
         Sexual Assault in the Military, in fiscal year 2010, the
         military services received 3,158 reports of alleged sexual
         assault involving servicemembers.

                                                                        5




11                                                  GAO-12-571R Military Personnel
Enclosure I




      Request Letter Questions

       You asked us the following:
       1.     How are cases of acute sexual assault reported, documented, and
              investigated, when victims are treated at a military treatment facility
              (MTF)?
       2.     What training is provided to health care professionals working in MTFs
              on the treatment of victims of sexual assault?
       3.     How do MTFs provide acute treatment and care to victims of sexual
              assault, including forensic medical-legal exams and mental health
              counseling, as well as preventative treatment for the human
              immunodeficiency virus (HIV), sexually transmitted diseases, and
              pregnancy?
       4.     What types of long-term services, support, and follow-up, including
              mental health services, do MTFs provide to victims of sexual assault?


                                                                                        6




12                                                              GAO-12-571R Military Personnel
Enclosure I




      Briefing Topics

       This briefing includes information on the following topics from
       our body of work, which correspond with the questions asked
       in the request letter:
             •    DOD’s approach for reporting, documenting, and investigating
                  alleged sexual assault incidents. (Question 1*)
             •    DOD training of servicemembers related to sexual assault.
                  (Question 2)
             •    DOD care and treatment provided to victims of sexual assault,
                  including mental health counseling and medical care. (Questions 3
                  and 4)



      *Ourprevious audit work focused on alleged sexual assault incidents within the military services and was not limited to only those incidents
      when the victim was treated at a MTF.

                                                                                                                                                7




13                                                                                                         GAO-12-571R Military Personnel
Enclosure I




      Scope and Methodology

       • Since 2008, our body of work has helped to inform
         Congress on issues related to sexual assault in the
         military.

       • The content of this briefing is primarily based on our body
         of work on DOD’s actions related to sexual assault in the
         military. Additionally, to compile this briefing we used
         information from the Fiscal Year 2010 Department of
         Defense Annual Report on Sexual Assault in the Military
         (the most recent year available) and DOD’s policies for
         medical care of alleged victims of sexual assault.

                                                                        8




14                                                  GAO-12-571R Military Personnel
Enclosure I




      Background

       • DOD Directive 6495.01, issued in October 2005, is the
         department’s comprehensive policy for the prevention of,
         and response to, sexual assault.*

       • DOD Instruction 6495.02, issued in June 2006, provides
         guidance for implementing the department’s policy.**

       • In addition to DOD’s policy, each military service provides
         sexual assault–specific guidance as well as standard
         operating and reporting procedures for responding to
         alleged sexual assault incidents.
       *Department    of Defense Directive 6495.01, Sexual Assault Prevention and Response (SAPR) Program (Oct. 6, 2005). DOD released
       revisions to its Directive in January 2012.
       **Department of Defense Instruction 6495.02, Sexual Assault Prevention and Response Program Procedures (June 23, 2006), as
       updated.

                                                                                                                                         9




15                                                                                                   GAO-12-571R Military Personnel
Enclosure I




      Background (cont.)

       • DOD and the military services rely largely on Sexual
         Assault Response Coordinators (SARCs) to implement
         Sexual Assault Prevention and Response (SAPR)
         programs at military installations, including coordinating
         the response to and reporting of sexual assault incidents.

       • Other responders include victim advocates, military
         lawyers (known as judge advocates), medical and mental
         health providers, criminal investigative personnel, law
         enforcement personnel, and chaplains.



                                                                      10




16                                                 GAO-12-571R Military Personnel
Enclosure I




      Background (cont.)

       • DOD Instruction 6495.02 requires the DOD Office of the
         Inspector General to oversee investigations of sexual
         assault and develop policy for conducting sexual assault
         investigations. Specifically, it directed the DOD Inspector
         General to:
              • Develop policy for DOD criminal investigative organizations—the
                U.S. Army Criminal Investigation Command, the Naval Criminal
                Investigative Service, and the Air Force Office of Special
                Investigations—and oversee their investigations of sexual assaults.
              • Oversee sexual assault training within the DOD investigative and
                law enforcement communities.
              • Collaborate with the Sexual Assault Prevention and Response
                Office as necessary on sexual assault matters.

                                                                                  11




17                                                             GAO-12-571R Military Personnel
Enclosure I




      1: DOD’s Approach for Reporting, Documenting,
      and Investigating Cases of Sexual Assault


       • Our previous work included information on reporting,
         documenting, and investigating allegations of sexual
         assault involving servicemembers.




                                                                     12




18                                                GAO-12-571R Military Personnel
Enclosure I




      1: Reporting, Documenting, and Investigating Sexual
      Assault
      Options for Reporting Sexual Assault Incidents

       • Under DOD’s policy, active duty servicemembers have
         two options for reporting an alleged sexual assault:
         (1) unrestricted, and (2) restricted.
              1. Under the unrestricted reporting option, the chain of command is
                 informed of the alleged sexual assault and may initiate an
                 investigation by the military criminal investigative organization of
                 jurisdiction.
              2. The restricted reporting option permits a victim to confidentially
                 disclose an alleged sexual assault to select individuals and receive
                 care without initiating a criminal investigation. Generally, a
                 restricted report may only be made to SARCs, victim advocates, or
                 medical personnel.

                                                                                    13




19                                                               GAO-12-571R Military Personnel
Enclosure I




      1: Reporting, Documenting, and Investigating Sexual
      Assault
      Data Collection and Reports to Congress
       DOD’s Sexual Assault Prevention and
       Response Office serves as the
       department’s single point of
       responsibility for sexual assault policy
       matters.* The office oversees the
       department’s collection and
       maintenance of data on reported
       sexual assaults involving
       servicemembers and is responsible for
       preparing the department’s annual
       report to Congress.


       *Except for legal processes provided under the Uniform Code of Military Justice and Manual for Courts-Martial that are assigned to the
       Judge Advocates General of the military services and criminal investigative policy matters that are assigned to the DOD Office of the
       Inspector General.


                                                                                                                                                14




20                                                                                                       GAO-12-571R Military Personnel
Enclosure I




      1: Reporting, Documenting, and Investigating Sexual
      Assault
      Centralized Sexual Assault Incident Database
       • In October 2008, Congress required DOD to implement a centralized,
         case-level database for collecting and maintaining information on sexual
         assaults involving members of the Armed Forces by January 2010.*
              •    The law specified that the database include information, if available, about the nature of
                   the assault, the victim, the offender, and the outcome of any legal proceedings
                   associated with the assault.


       • In February 2010, we reported that DOD had not met the January 2010
         deadline, though it had taken preliminary steps to implement a
         centralized, case-level sexual assault incident database. Accordingly,
         we recommended that DOD adhere to key system development and
         acquisition management processes and controls in developing its
         database. DOD concurred with our recommendations.

       *TheDuncan Hunter National Defense Authorization Act for Fiscal Year 2009, Pub. L. No. 110-417, § 563, 122 Stat. 4356, 4470-71
       (2008).


                                                                                                                                        15




21                                                                                                    GAO-12-571R Military Personnel
Enclosure I




      1: Reporting, Documenting, and Investigating Sexual
      Assault
      Centralized Sexual Assault Incident Database (cont.)
       • DOD noted that it expects the database to be fully
         operational by August 2012.*

                • Specifically, according to a March 2011 status report from DOD’s
                  Office of Personnel and Readiness, a contract was awarded in
                  August 2010 for the development, implementation, and
                  maintenance of the database.

                • The report also highlighted the department’s adherence to key
                  information technology management practices and that its actions
                  were consistent with the recommendations in our February 2010
                  report.
       *Officials
               in DOD’s Sexual Assault Prevention and Response Office noted that they expect the database to be initially operational on
       March 30, 2012.


                                                                                                                                           16




22                                                                                                     GAO-12-571R Military Personnel
Enclosure I




      1: Reporting, Documenting, and Investigating Sexual
      Assault
      Military Services’ Approaches to Investigating Sexual Assaults
       •   In June 2011, we reported that absent DOD-level guidance, the military services
           have developed and implemented their own guidance on sexual assault
           investigations, and in some cases they take different approaches to conducting
           their investigations. Accordingly, we recommended that DOD develop and
           implement a policy that specified procedures for conducting sexual assault
           investigations. In addition, we recommended that the services leverage each
           other’s resources for investigating and adjudicating alleged sexual assault
           incidents.
       •   DOD concurred and has drafted a sexual assault investigations policy that would
           be applicable to the services’ military criminal investigative organizations and
           has taken other steps to coordinate expertise and resources of the services’
           criminal investigative organizations.
       •   We also reported that, according to the judge advocates from each of the
           military services, the administration of justice in sexual assault cases is often
           complicated by limited availability of forensic evidence and conflicting testimonial
           accounts by the parties involved.

                                                                                             17




23                                                                    GAO-12-571R Military Personnel
Enclosure I




      1: Reporting, Documenting, and Investigating Sexual
      Assault
      Forensic Evidence Maintenance Standards Vary across Military Services
       Comparison of Sexual Assault Forensic Maintenance Standards Across Military Services

                                        Army Criminal                  Air Force Office of               Naval Criminal
                                        Investigation Command          Special Investigations            Investigative Service

        Forensic evidence               Unrestricted cases:            Unrestricted cases: Air           Unrestricted cases:
        maintenance standards           Unsolved rapes and             Force Office of Special           Unsolved rape case
                                        aggravated sexual assault      Investigations’ guidance does     evidence is held for a
                                        evidence is retained           not specify time frames for       minimum of 50 years.
                                                                       maintaining evidence in these
                                        indefinitely.
                                                                       cases, but officials told us
                                                                       that evidence is disposed of      Restricted cases: Forensic
                                        Restricted cases:              when no longer required,          examination kits are stored
                                        Evidence stored by             after a judge advocate            for 12 months, then
                                        installation-level law         approves the disposition.         destroyed if victim does not
                                        enforcement for 1 year.                                          convert the restricted report
                                                                       Restricted cases: Evidence        to an unrestricted report.
                                                                       is stored for at least 1 year,
                                                                       then destroyed if the victim
                                                                       does not convert to an
                                                                       unrestricted report after being
                                                                       notified of the expiration of
                                                                       the storage period.



        Source: GAO analysis of the military services' investigative organizations' policies and procedures.

                                                                                                                                     18




24                                                                                                  GAO-12-571R Military Personnel
Enclosure I




      2: DOD’s Sexual Assault Prevention and
      Response Training

       • Our previous work included information on training
         provided to servicemembers related to sexual assault
         prevention and response.




                                                                    19




25                                               GAO-12-571R Military Personnel
Enclosure I




      2: Sexual Assault Prevention and Response Training
      SAPR Training and Resulting GAO Recommendations


       • In August 2008, we reported that DOD’s SAPR training was not
         consistently administered and that the effectiveness of the training
         provided to servicemembers on SAPR policies had not been
         systematically evaluated by DOD. Accordingly, we recommended that
         DOD review and evaluate SAPR training programs for greater
         effectiveness. DOD concurred with this recommendation and has
         implemented it.

       • In February 2010, we reported that the Office of the Secretary of
         Defense’s (OSD) training subcommittee found that a greater level of
         detail was needed in policy to guide the execution of training
         requirements.


                                                                                20




26                                                          GAO-12-571R Military Personnel
Enclosure I




      2: Sexual Assault Prevention and Response Training
       SAPR Training and Resulting GAO Recommendations (cont.)


       • We also reported in February 2010 that OSD chartered the
         Health Affairs Sexual Assault Task Force to address a
         recommendation we made in 2008 to evaluate and
         develop an action plan to address factors that may prevent
         or discourage servicemembers from seeking mental health
         services. In March 2009, the task force made a number of
         recommendations intended to improve the availability of
         health care, such as chartering the Sexual Assault Health
         Care Integrated Policy Team to review SAPR training
         requirements and responsibilities.*


       *The  Sexual Assault Health Care Integrated Policy Team was established by the Office of the Assistant Secretary of Defense for Health
       Affairs in October 2009 to facilitate effective and efficient coordination of sexual assault response matters in the DOD medical
       community.


                                                                                                                                            21




27                                                                                                      GAO-12-571R Military Personnel
Enclosure I




      2: Sexual Assault Prevention and Response Training
      Evaluation of Investigator Training

       • In June 2011, we reported that while each of the military services has
         developed and implemented sexual assault-specific training for its
         respective investigators (per DOD policy), the DOD Office of the
         Inspector General has not worked with the services to assess the
         content or the effectiveness of the training that is being provided.

       • We also reported that the DOD Office of the Inspector General had not
         assessed the training that is provided by the services on sexual assault
         investigations, such as evaluating how many investigators are currently
         meeting a minimum standard of competency. Accordingly, we
         recommended that DOD develop and implement clear goals and
         objectives for monitoring and evaluating the services’ sexual assault
         investigations and related training. DOD concurred, and the DOD Office
         of the Inspector General has begun an evaluation of the military criminal
         investigative organizations’ training on sexual assault investigations.


                                                                                  22




28                                                           GAO-12-571R Military Personnel
Enclosure I




      3: DOD Care and Treatment Provided to
      Victims of Sexual Assault
       •   Our previous work on care and treatment provided to victims of
           sexual assault included information on mental health services.
       •   In addition to our previous work, this information is also based
           on a review of DOD health care related policies.
            • Department of Defense Directive 6495.01, Sexual Assault
               Prevention and Response (SAPR) Program (Oct. 6, 2005).
            • Department of Defense Instruction 6495.02, Sexual Assault
               Prevention and Response Program Procedures (June 23,
               2006).




                                                                              23




29                                                       GAO-12-571R Military Personnel
Enclosure I




      3: Care and Treatment
      Coordination and Tracking of Victim Services



       •   SARCs are required to coordinate medical and counseling
           services between military installations and deployed units for
           victims of sexual assault. They also are to collaborate with local
           community crisis counseling centers to augment or enhance
           DOD’s program.

       •   We found that program officials generally took steps to ensure
           that servicemembers who were sexually assaulted were made
           aware of their options for seeking mental health care and were
           able to access it, if desired.



                                                                             24




30                                                        GAO-12-571R Military Personnel
Enclosure I




      3: Care and Treatment
      Factors that Affect Access to Mental Health Care


       •     In August 2008, we reported that a DOD-reported shortage of health
             care providers—specifically mental health care providers—could
             hinder servicemembers’ access to receiving mental health care. DOD
             established a memorandum of understanding (MOU) to allow
             uniformed providers of the Public Health Service to work in MTFs.*

       •     Perceptions of stigma associated with seeking mental health care also
             may discourage servicemembers from doing so following a sexual
             assault. DOD officials told us that stigma may prevent servicemembers
             from seeking health care. They also may believe that doing so could
             negatively impact their careers, such as by affecting their ability to
             obtain a security clearance.


      *The Public Health Service Commissioned Corps within the United States Department of Health and Human Services is a team of public
      health professionals that fills essential public health leadership and service roles within the nation's federal government agencies and
      programs.

                                                                                                                                             25




31                                                                                                        GAO-12-571R Military Personnel
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      3: Care and Treatment
      Efforts to Improve the Availability of Health Care

       • In August 2008, we recommended that DOD
         systematically evaluate and develop an action plan to
         address any factors that may prevent or discourage
         servicemembers from accessing mental health services
         following a sexual assault. DOD concurred and has
         implemented this recommendation.

       • In March 2009, OSD chartered the Health Affairs Sexual
         Assault Task Force which made a number of
         recommendations intended to improve the availability of
         health care.

                                                                              26




32                                                         GAO-12-571R Military Personnel
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      3: Care and Treatment
      Efforts to Improve the Availability of Health Care (cont.)

       • The Health Affairs Sexual Assault Task Force
         recommendations included:
              • Chartering the Sexual Assault Health Care Integrated Policy Team
                to review department-level policies regarding clinical practice
                guidelines, standards of care, research gaps and opportunities,
                personnel and staffing, training requirements and responsibilities,
                continuity of care, and in-theater equipment and supplies.

              • Drafting model MOUs for use by all service military treatment
                facilities as they establish continuity of care relationships with local
                community providers.




                                                                                           27




33                                                                 GAO-12-571R Military Personnel
Enclosure I




      3: Care and Treatment
      Medical Care Policies


       •   According to DOD’s Instruction, SARC notification must not delay the
           treatment of any medical conditions requiring immediate attention for
           the health of a servicemember seeking care for an alleged sexual
           assault at an MTF.

       •   Once clinically stable, the healthcare provider shall consult with the
           servicemember regarding further healthcare options including, but not
           limited to:
              •   An optional sexual assault forensic exam.
              •   Testing, prophylactic treatment options, and follow-up care for possible exposure to
                  HIV and other sexually transmitted infections or diseases.
              •   Assessment of the risk of pregnancy, options for emergency contraception, and any
                  necessary follow-up care and/or referral services.
              •   Assessment of the need for behavioral health services and providing a referral, if
                  necessary and/or requested by the victim.

                                                                                                         28




34                                                                             GAO-12-571R Military Personnel
Enclosure I




      3: Care and Treatment
      Sexual Assault Forensic Exams (SAFE)


       •   Victims are entitled to an optional SAFE exam.

       •   Installations that do not have a SAFE capability will transport a victim to
           a military facility or local off-base non-military facility that has a SAFE
           capability.

       •   Whenever possible, military installations should have established
           formal MOUs with military facilities and off-base non-military facilities
           for the purpose of conducting sexual assault examinations.

       •   The SARC or victim advocate will ensure that a victim is aware of any
           local or state sexual assault reporting requirements that may limit the
           possibility of restricted reporting, prior to proceeding with the SAFE at
           the local off-base non-military facility.

                                                                                       29




35                                                               GAO-12-571R Military Personnel
Enclosure I




      Recommendations from Previous GAO
      Reports
       • In our work, we made 25 recommendations aimed at
         improving the implementation and oversight of DOD’s
         SAPR program. DOD concurred or partially concurred with
         all 25 recommendations.

       • Our analysis shows that, to date, DOD has fully
         implemented 13 recommendations and has partially
         implemented the remaining 12 recommendations.




                                                                   30




36                                              GAO-12-571R Military Personnel
Enclosure I




      Previous GAO Reports

       •   Military Justice: Oversight and Better Collaboration Needed for Sexual
           Assault Investigations and Adjudications. GAO-11-579. Washington,
           D.C.: June 22, 2011.

       •   Military Personnel: Additional Actions Are Needed to Strengthen DOD's
           and the Coast Guard's Sexual Assault Prevention and Response
           Programs. GAO-10-215. Washington, D.C.: February 3, 2010.

       •   Military Personnel: DOD's and the Coast Guard's Sexual Assault
           Prevention and Response Programs Face Implementation and
           Oversight Challenges. GAO-08-924. Washington, D.C.: August 29,
           2008.

       •   Military Personnel: DOD and the Coast Guard Academies Have Taken
           Steps to Address Incidents of Sexual Harassment and Assault, but
           Greater Federal Oversight Is Needed. GAO-08-296. Washington, D.C.:
           January 17, 2008.

                                                                                    31




37                                                            GAO-12-571R Military Personnel
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      Previous GAO Testimonies

       •   Military Personnel: DOD's and the Coast Guard's Sexual Assault
           Prevention and Response Programs Need to Be Further Strengthened.
           GAO-10-405T. Washington, D.C.: February 24, 2010.

       •   Military Personnel: Actions Needed to Strengthen Implementation and
           Oversight of DOD's and the Coast Guard's Sexual Assault Prevention
           and Response Programs. GAO-08-1146T. Washington, D.C.:
           September 10, 2008.

       •   Military Personnel: Preliminary Observations on DOD's and the Coast
           Guard's Sexual Assault Prevention and Response Programs.
           GAO-08-1013T. Washington, D.C.: July 31, 2008.




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38                                                          GAO-12-571R Military Personnel
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