[House Hearing, 111 Congress] [From the U.S. Government Publishing Office] [H.A.S.C. No. 111-135] LEGISLATIVE PRIORITIES IN SUPPORT OF FAMILIES __________ HEARING BEFORE THE MILITARY PERSONNEL SUBCOMMITTEE OF THE COMMITTEE ON ARMED SERVICES HOUSE OF REPRESENTATIVES ONE HUNDRED ELEVENTH CONGRESS SECOND SESSION __________ HEARING HELD MARCH 15, 2010 [GRAPHIC] [TIFF OMITTED] TONGRESS.#13 U.S. GOVERNMENT PRINTING OFFICE 57-699 WASHINGTON : 2010 ----------------------------------------------------------------------- For Sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; (202) 512�091800 Fax: (202) 512�092104 Mail: Stop IDCC, Washington, DC 20402�090001 MILITARY PERSONNEL SUBCOMMITTEE SUSAN A. DAVIS, California, Chairwoman VIC SNYDER, Arkansas JOE WILSON, South Carolina LORETTA SANCHEZ, California WALTER B. JONES, North Carolina MADELEINE Z. BORDALLO, Guam JOHN KLINE, Minnesota PATRICK J. MURPHY, Pennsylvania THOMAS J. ROONEY, Florida HANK JOHNSON, Georgia MARY FALLIN, Oklahoma CAROL SHEA-PORTER, New Hampshire JOHN C. FLEMING, Louisiana DAVID LOEBSACK, Iowa NIKI TSONGAS, Massachusetts Mike Higgins, Professional Staff Member Jeanette James, Professional Staff Member James Weiss, Staff Assistant C O N T E N T S ---------- CHRONOLOGICAL LIST OF HEARINGS 2010 Page Hearing: Monday, March 15, 2010, Legislative Priorities in Support of Families....................................................... 1 Appendix: Monday, March 15, 2010........................................... 21 ---------- MONDAY, MARCH 15, 2010 LEGISLATIVE PRIORITIES IN SUPPORT OF FAMILIES STATEMENTS PRESENTED BY MEMBERS OF CONGRESS Davis, Hon. Susan A., a Representative from California, Chairwoman, Military Personnel Subcommittee.................... 1 Wilson, Hon. Joe, a Representative from South Carolina, Ranking Member, Military Personnel Subcommittee........................ 2 WITNESSES Cohoon, Dr. Barbara, Government Relations Deputy Director, National Military Family Association........................... 4 Hruska, Kelly, Government Relations Deputy Director, National Military Family Association.................................... 4 Moakler, Kathleen B., Government Relations Director, National Military Family Association.................................... 3 Savant, Katie, Government Relations Deputy Director, National Military Family Association.................................... 5 Wheeler, Candace, Government Relations Deputy Director, National Military Family Association.................................... 5 APPENDIX Prepared Statements: Davis, Hon. Susan A.......................................... 25 Moakler, Kathleen B., joint with Dr. Barbara Cohoon, Kelly Hruska, Candace Wheeler, and Katie Savant.................. 28 Wilson, Hon. Joe............................................. 26 Documents Submitted for the Record: [There are were no Documents submitted.] Witness Responses to Questions Asked During the Hearing: [There were no Questions submitted during the hearing.] Questions Submitted by Members Post Hearing: [There were no Questions submitted post hearing.] LEGISLATIVE PRIORITIES IN SUPPORT OF FAMILIES ---------- House of Representatives, Committee on Armed Services, Military Personnel Subcommittee, Washington, DC, Monday, March 15, 2010. The subcommittee met, pursuant to call, at 5:34 p.m., in room 2118, Rayburn House Office Building, Hon. Susan A. Davis (chairwoman of the subcommittee) presiding. OPENING STATEMENT OF HON. SUSAN A. DAVIS, A REPRESENTATIVE FROM CALIFORNIA, CHAIRWOMAN, MILITARY PERSONNEL SUBCOMMITTEE Mrs. Davis. Good afternoon, everybody. Let me just get my sea legs for two seconds, having just flown in, but I really appreciate your all being here. This is such an important topic and we are pleased that such a broad group of folks from the Military Family Association, with your expertise and help and support, could be with us. We are looking forward to this hearing. Thank you. The hearing will come to order. The focus of today's hearing is a review of the priority legislative initiatives needed to support military families, and we have asked the National Military Family Association, the association with the greatest expertise regarding family issues, to help us understand how the Congress can best assist our military families. This hearing follows a subcommittee hearing on March 9, just last week, that featured researchers from the RAND Corporation and the Army War College, who related the conclusions of two studies to assess the effects of deployment on military children. The RAND study, as you know, was sponsored by the National Military Family Association, and I want to congratulate the association for investing in an excellent study that advanced our knowledge of the toll that war exacts from the children of those that serve. This is the second of our hearings scheduled to last for the one hour that is available to us prior to our votes at 6:30, so I would ask you to remain mindful of that. I think this is a terribly important topic, and as I read through all of your comments and the work that you have put into it, it may be that we need to go on and schedule again, but I know trying to get here are at 5:30 isn't always easy from California; so we will do what we can. I also wanted to thank you for the emphasis that you had on mental health and for looking at the whole family because I think those are very important issues. I think we have addressed it to a limited extent, but I am hoping that throughout the discussion that we can focus on it some more. I want to welcome our witnesses: Mrs. Kathleen Moakler, Government Relations Director, and I know you have been in that place for a long time. Thank you. Dr. Barbara Cohoon, Government Relations Deputy Director; Ms. Kelly Hruska, Government Relations Deputy Director as well; Mrs. Candace Wheeler, also Government Relations Deputy Director; and Ms. Katie Savant, a Government Relations Deputy Director also. So once again thank you so much and I know Mr. Wilson that you will have a comment. Thank you. [The prepared statement of Mrs. Davis can be found in the Appendix on page 25.] STATEMENT OF HON. JOE WILSON, A REPRESENTATIVE FROM SOUTH CAROLINA, RANKING MEMBER, MILITARY PERSONNEL SUBCOMMITTEE Mr. Wilson. Thank you, Chairwoman Davis, for holding this hearing and thank each of you for being here today. We certainly appreciate all of your service on behalf of military families. Meeting the needs of military families continues to be challenging and complex. We are a nation at war fighting on two fronts and the strains of those wars translate directly and immediately to the families of members of the armed forces. When the military family unit is disrupted by deployment of a key member of the family, a host of issues arise that stress all aspects of family life--physical and mental health, personal finances, interpersonal relationships just to name a few. With two sons having served in Iraq and another in Egypt, I know the challenges. This subcommittee, the Department of Defense, and the military services have taken a number of initiatives to address the needs of military families. Yet there remains evidence much more needs to be done and the system of support that has been created may not be adequately meeting the needs of military families. Last week we heard testimony on the results of two studies that looked at the effects on military children who have deployed parents. Thankfully, these studies seem to suggest our military children are more resilient than we could expect. With that said, it is also clear that the well-being of our children is affected by the stability of their family and the emotional strength of the non-deployed parent among other factors. While I appreciate the Department of Defense and military services are committed to assisting and supporting military families, I am not convinced the right services are getting to the right family members at the right time. I am also concerned the provisions of family support services are not always completely coordinated and integrated. I am also interested in hearing from our witnesses how effective the coordination and integration effort is. I am also interested in hearing where we must provide additional effort in the form of policy and resources to improve what is already being done. With that, Madam Chairwoman, I join you in welcoming our witnesses and I look forward to the testimony. [The prepared statement of Mr. Wilson can be found in the Appendix on page 26.] Mrs. Davis. Thank you, Mr. Wilson. I know that you have a plan to present a rather quick overview and we look forward to that. Thank you. Mrs. Moakler, if you would like to begin. STATEMENT OF KATHLEEN B. MOAKLER, GOVERNMENT RELATIONS DIRECTOR, NATIONAL MILITARY FAMILY ASSOCIATION Mrs. Moakler. Thank you. Chairwoman Davis, Ranking Member Wilson, and other distinguished committee members, thank you for the opportunity to speak today on behalf of military families, our nation's families. Many families are facing their eighth year of deployments. Many have dealt with multiple deployments. We have second graders who have lived with a parent absent from their lives for months at a time over and over again. It is the only life they know. We appreciate the many initiatives and programs supported by this subcommittee in years past for our service members, retirees, their families, and their survivors. They have become part of the overall fabric of family readiness. The challenge that now faces us is making sure that our family readiness programs receive sustained funding and are included in the annual budget process. With budget cuts and shortfalls looming, we should not randomly reduce funding to family programs and services across the board. Service members and their families cite morale, welfare, and recreation (MWR) programs like gyms, libraries, and other installation-provided service as important to their well-being during deployments. Substantial cuts to these programs make them wonder why services talk about support yet often cut or reduce the same programs that are identified as the most important by our families. One of the ways to evaluate the efficacy of programs is research. In May 2008, we commissioned the RAND Corporation to do a longitudinal study on the experience of 1,500 families. You had the opportunities to hear the result of that study in a hearing last week. Our role now is to determine how we use these findings to target support to enhance the strength of military families. If total months deployed matter, how do we maintain health in the families that are doing okay--that is 70 percent--as they experience more deployments? How do we target programs to meet the needs of families of school-aged children while not diminishing support for families with younger children? How do we engage those who interact with older youth, especially girls, with additional information and resources? How do we foster relationships between deployed parents, at-home caregivers and older children to facilitate healthy reintegration? And how do we help caregivers of older children and youth strike a work/life balance? What can Congress, Department of Defense (DOD), and communities do to help in this effort? Ensure funding for military family programs consistent with the demands created by eight plus years of war; fund YMCA memberships for teams and families through the existing DOD contract for at least six months post-deployment; develop effectiveness measures for all family programs; identify and replicate best practices, camping programs, community outreach, and a focus on reintegration. And, as a point of information, we have had 2,552 applications submitted since our Operation Purple site opened this morning. We also need to publicize resources available to support military families and engage nonprofits to identify and meet needs of local military families. The National Military Family Association for our part is going to gather the best minds at a summit in May to engage in a national conversation focused on military children and families. We hope to develop recommendations into a blueprint for action. And now we will hear from Dr. Cohoon. STATEMENT OF DR. BARBARA COHOON, GOVERNMENT RELATIONS DEPUTY DIRECTOR, NATIONAL MILITARY FAMILY ASSOCIATION Dr. Cohoon. Chairman Davis, Ranking Member Wilson, and distinguished members of this subcommittee, health care access continues to be an issue. The recent implementation and then deferment of Medicare reimbursement rate cuts has only heightened our military families' access concerns. Our Association asserts that behind every wounded service member is a wounded family. As the war continues, families are also experiencing their own invisible wounds and their need for behavioral health services will remain high even after military operations scale down. We appreciate the inclusion of service member caregiver compensation in the National Defense Authorization Act (NDAA) fiscal year 2010; however, we believe this provision did not go far enough. Compensation should be a priority. Current law creates a potential gap in compensation following transition and did not include training, health care, and expanded respite care benefits. In order for caregivers to perform their job well, they must be given the skills to succeed. This will require training through a standardized civilian-certified program and appropriately compensated. The caregiver self-selection process occurs during the early phase of recovery; therefore benefits must be established while they are still upstream on active duty. And now we will hear from Kelly Hruska. STATEMENT OF KELLY HRUSKA, GOVERNMENT RELATIONS DEPUTY DIRECTOR, NATIONAL MILITARY FAMILY ASSOCIATION Ms. Hruska. Chairwoman Davis, Ranking Member Wilson, distinguished members of the subcommittee, thank you for the opportunity to speak today about the exceptional family member program. We appreciate the legislation to establish an office for community support for military families with special needs in this year's NDAA. Our families are anxious for it to stand up and we are closely monitoring its progress. However, we must remember that our special needs families often require medical, educational, and family support resources. This new office must address all these various needs in order to effectively implement change. This new office will go a long way in identifying and addressing special needs, and we will look forward to working with you to remedy these issues as they arise. And now we will hear from Candace Wheeler. STATEMENT OF CANDACE WHEELER, GOVERNMENT RELATIONS DEPUTY DIRECTOR, NATIONAL MILITARY FAMILY ASSOCIATION Mrs. Wheeler. Chairwoman Davis, Ranking Member Wilson, and distinguished members of our subcommittee, our association has long realized the unique challenges our National Guard and Reserve families face and their need for additional support. Our Reserve Component families are often geographically dispersed, live in rural areas, and do not have the same family support programs as their active duty counterparts. However, in the past several years, great strides have been made by Congress and the services to help strengthen Reserve Component families. We thank you for these important provisions and ask that their funding be included in the baseline budget. We appreciate Congress's attention to the Yellow Ribbon program by including reporting requirements in last year's NDAA. To ensure that Yellow Ribbon services are consistent across the nation, we urge you to conduct oversight hearings as well. We also ask that the definition of family member be expanded to allow non-I.D. cardholders to attend these important programs in order to support their service member and gain valuable information. Although our association applauds the innovative behavioral health support programs for our Reserve Component families such as Military OneSource, TRICARE Assistance Program (TRIAP), and Military Family Life Consultants, we remain concerned that not all National Guard and Reserve families have mental health care services where they live. And now we will hear from Katie Savant. STATEMENT OF KATIE SAVANT, GOVERNMENT RELATIONS DEPUTY DIRECTOR, NATIONAL MILITARY FAMILY ASSOCIATION Ms. Savant. Chairwoman Davis, Ranking Member Wilson and distinguished members of this subcommittee, enhanced military spouse education and employment opportunities are critical to the quality of life of military families. The sudden halt of the DOD MyCAA program was a financial and emotional strain to nearly 137,000 spouses. We are pleased the program has been reinstated for those currently enrolled. MyCAA provides critical financial support to spouses through all levels of their career progression whether the spouse is new to the workforce or a mid-level professional. Military spouses feel empowered and recognized by DOD through this program. We ask this subcommittee to fully fund the program not only for currently enrolled spouses but for those who will need the funding in the future. Our military community is experiencing a shortage of medical, mental health, and child care providers. Many of our spouses would like to seek training in these professions. We encourage DOD to create portable career opportunities for spouses seeking in-demand professions. By providing the opportunity to grow our own, DOD will help alleviate provider efficiencies. Thank you for your support of service members and their families. We urge you to remember their service as you work to resolve the many issues facing our country. Working together we can improve the quality of life for all military families. We welcome any questions you may have. [The joint prepared statement of Mrs. Moakler, Dr. Cohoon, Ms. Hruska, Mrs. Wheeler, and Ms. Savant can be found in the Appendix on page 28.] Mrs. Davis. Thank you very much. I appreciate all of your comments. Perhaps before we start, I think one of the things that is so difficult, and I mentioned in my opening remarks briefly, is prioritizing among all these demanding issues that we have before us, and I know that is really difficult. We may try from time to time to see if we can do some of that. I think that part of the difficulty is we are not comparing apples to apples here, and I don't want to use that in a flippant way, but I think that it is very difficult to say, well, this is more important than that. And yet somehow in there we need to try to do important things to the best of our ability and I think that we look to you because you know the situation of our families far better and you are far closer to the families than we are individually here. And so as we go through if there is a way of helping us out with that issue, I think, it would be very helpful to do that. If I may just go to Ms. Savant for a second because you brought up MyCAA. We call it MICA here. I know that is probably not the best way to do it. But I wanted to just say as well that I think the reason that we were able to move so swiftly with this was because of the response of our military family members who reacted very quickly. They were alarmed and concerned and I think very upset when they saw initially that the program had been pulled at least temporarily. So we are very pleased to see that come back online. I am wondering as we deal with this, and you mentioned those spouses particularly, who perhaps did not have their applications in and we know will want to do that in the future, I am wondering how you might suggest that we go forward, what suggestions you might have to structure the program to fulfill the promise of these real educational opportunities and portable professions that we need desperately in the services in a fair and cost-effective manner. And I don't know if you have any thoughts about how to reduce the costs at all or how you see this coming together. Do you have some thoughts and suggestions? Ms. Savant. Sure. Chairwoman Davis, I would definitely say that costs are not something that is my expertise, but I would say that this is something that was initially open to all DOD military spouses. And as you know, the sudden halt was definitely detrimental to their education and career paths. We had students who not only were dropped out of courses but some had to take incompletes, and that can really impact their future career progression. So I think that it is great that DOD is doing a review of the program, but we do need to make sure that funding continues for military spouses who want to continue to pursue portable careers. It is something that maybe a spouse shouldn't use initially because they weren't expecting permanent change of station (PCS) orders to move, but they are this summer and they might be going to a new state where they are required to take new courses in order to continue their profession. This funding is critical to them. So I apologize I am not able to help with determining funding, but I do think that it is critical that we continue this program. Mrs. Davis. Does anybody else want to comment on that? Great. One of the larger areas that we deal with is pay raise, and over the last number of years, there has been a real attempt to provide an additional bump of a half a percentage point to bring military salaries more in line with the private sector. This year the proposal does not include that, and yet we know that it really is reflecting a raise but not the additional bump and partly because we have so many needs out there and I know that the Department of Defense is suggesting that we have come very close, but I would suggest that we are not quite there yet. Can you help us to see--we have about 11 years of history by which to judge these relatively minor advancements to pay levels and does it trump other issues in terms of the number one priority that families have? Are there other priorities that you think may really be more critical right now? Mrs. Moakler. We don't usually address pay issues as an organization, but I know as members of the military coalition we are in favor of a pay raise. And as long as there wasn't a great discrepancy as there was several years ago, we are very pleased of the fact that it has caught up to outside pay raises. But if we could focus on the mid-career folks because they are the ones that are getting out and so we would like to make sure that they have some incentive to stay in. Mrs. Davis. I have just a second, but can I ask along with those priorities as we look at that issue the Survivor Benefit Plan-Dependency and Indemnity Compensation (SBP-DIC) offsets, how that really fits into this? A tough question, I know. I understand that. Mrs. Moakler. We have long been supporters of the elimination of the DIC offset to the SBP, and we feel that that is an important way to respect both the wishes of the service member who had, for the most part, for retirees had paid into the SBP fund to provide for his family and that the DIC is a separate benefit. That is supposed to reimburse you for any injuries or the death of the service member, so that each has a different reason to be paid out, and so we really support that that be eliminated. Mrs. Davis. Thank you. Mr. Wilson. Mr. Wilson. Thank you very much, and again thank all of you for being here and I appreciate the individual testimony and I have never seen such brevity; so thank you very much. For any of you, I would like to ask--it has been mentioned in the testimony that there are redundancies in military family programs and some programs don't meet the needs of today's military families. Are there any programs existing today that in your opinion should be terminated? If so, what are they? Mrs. Moakler. Well, I think we need to look at the myriad of services that are provided by each of the services, and especially in the area of information and referral. It seems like people are starting up new programs to collect information from community sources and get them out there for military families. But there are so many areas to choose from that it gets confusing. So if there could be one list, the National Resource Directory is a good start, that it be a Purple list. We are all about having Purple programs for families. And not that they would lose their individual alternate but sometimes too many resources can be confusing. Mr. Wilson. And the Internet can be a real resource to help get through so you can find it for a particular community. Mrs. Moakler. Yes. You could put in your zip code and find out where those resources are. Mr. Wilson. Again, to me, it is exciting that they are so available technologically for families. Another recommendation has been to establish a unified joint medical command structure within DOD. Can you explain how this would be helpful? Dr. Cohoon. That would be me on this particular one. I handle health care for our organization. What we have talked about is right now what we are dealing with--the funding happens under three different services rather than as far as it being joint, and we are looking at what is happening with the National Capital region and how that is rolling out. And as we are looking at programs that are rolling out, sometimes the best practices aren't necessarily shared across services. And as we stand up at the National Capital region where you have Army and Navy working together, and down in San Antonio you have Air Force and Army working together, the ability to be able to share resources so you are purchasing the same equipment, you are teaching your staff as far as utilizing the same policies would go a long way as far as keeping down costs but also improving the quality of care through efficiencies but also as far as patient safety. Mr. Wilson. Another example would be the Uniform Services University, which is a joint service university and since one of my sons is a graduate, I know it is a great institution. So I hope we can possibly look into what you suggest. Dr. Cohoon. We look forward to working with you on that. Mr. Wilson. That would be great. Then again for anyone who would like to answer, it has been suggested that the system of multilayered case managers for wounded service members and their families may be aggravating the delivery of necessary services to the families. How would you streamline the process to make it more effective? Dr. Cohoon. What we are seeing, again, is all the services are rolling out their own programs and their own level of case managers. The Department of Veterans Affairs (VA) is doing the same thing. Also we have DOD doing the same thing. And our families are getting confused as far as who do you go to for what and when. So we have been asking for basically maybe a report to take a look, and I knew the GAO was looking at the federal recovery coordinators to see how effective they are being. But also we need to look at recovery care coordinators and everyone else. What we are finding is that the families sometimes aren't aware that certain case managers are available that they could utilize, i.e. the federal recovery coordinators, or that they are in the VA and that now they could be using the VA case managers, and instead, they are still utilizing the services on top of that. So there is a lot of great programs, but we want to make sure that we take a look that we haven't added so many on that it is getting confusing for the families. Mr. Wilson. Well, your organization serves such a vital function as a safety net and as a means of providing assistance to families. So I hope you all continue that effort, and I am particularly concerned about a person's going from DOD care to VA care, that that be as seamless as possible and without a hiccup so that people receive services with nobody to fall between the cracks. So thank you very much for your time. Mrs. Davis. Thank you. Ms. Bordallo. Ms. Bordallo. Thank you, Madam Chairman and Ranking Member Wilson. And I do want to thank you ladies for your testimony, and it looks as if services for military families is in very good shape from what I have heard. You know, it is an old adage that it is not just the man or the woman in uniform that serves but the entire family, and I truly believe in that. In recognition for your role, our chairman recently, Mr. Ike Skelton, worked to have this year designated as the year of the military family, and while Congress has done much, there is still a lot more to be done. Now, the National Military Family Association has been a strong supporter of the reporting requirements in the 2010 National Defense Authorization bill, and as you know, this bill requires the Secretary of Defense to examine the housing standards used to distinguish between grades when setting housing allowance rates. Some complaints surrounding the notion that junior enlisted members and their families can be housed in apartments while town homes are adequate for mid-grade noncommissioned officers. Opponents of the standard believe all families should be housed in separate housing units, which is the general standard for the United States. I would like to focus on this matter with reference to the Marine buildup. I am the representative from the territory of Guam. And the current plan involves significant acquisition of our land in Guam in order to house the 8,600 additional Marines and their families. Due to the significant concern regarding the draft environmental impact statement, I have offered some proposed alternatives to the main bed-down location of the Marines. I have proposed using less land by housing Marines in vertical structures such as condominiums. I understand that we would all like to have a home and a yard but, in some cases, this is just not possible. So with that in mind, and I know--I don't know which one of you is a military housing expert, but with that in mind, could you comment on any concerns that you would have about building more vertical structures on Guam to house our Marine families? Could anybody give us some idea? Ms. Savant. Ma'am, I wouldn't consider myself an expert, but I can certainly try to answer that question for you. I definitely think that we need to look at the area where the housing is going to be, whether it is in Guam, whether it is in Japan, Hawaii, and we need to have standards that meet the standards of that community. If that is vertical housing in Guam, then that is the standards of that community. Certainly military families do like to have homes, but that is not always available in certain areas. In city dwellings there are high- rise apartments, and I think as long as the dwellings are meeting the standards of the community and have all the safety features that are required, then those are reasonable standards to have. Ms. Bordallo. So as an association, if the standards are up to par, you wouldn't have any objection. Is that pretty much-- -- Ms. Savant. Yes. Ms. Bordallo. All right. Thank you. Now one more question. I would like to get everyone's take on the implementation across this nation of home station mobilization and demobilization for our National Guard and Reserves. I am concerned that this is not occurring as Congress intended. I am wondering what your thoughts are on this process and what more we can do to make this a reality. As you all know it significantly degrades military readiness when we force families to travel to active duty locations far from their homes. So we need to maintain the readiness of our families by fully implementing a home station mobilization and demobilization. Mrs. Wheeler. Ma'am, we couldn't agree with you more. Ms. Bordallo. Mrs. Wheeler. Mrs. Wheeler. Yes, I am Candace Wheeler. And we agree, making sure that family has all the support that they have and not necessarily having them move during that period of time and giving them all the support. We see a lot of our Guard and Reserve actually serving as individual augmentees as well. So we need to make certain that those families have the support they need also. But, yes, we would support that. Ms. Bordallo. Thank you very much and I thank you for your service. It is very important the work you are doing. Mrs. Wheeler. Thank you. Mrs. Davis. Thank you. Mr. Loebsack. Mr. Loebsack. Thank you, Madam Chair and Ranking Member Wilson for having this important hearing. I thank all of you on the panel for everything you are doing. It is often said that there are a lot of divisions in this Congress on party lines, and there are. I think it is fair to say that Congressman Wilson and I probably don't agree on very much of anything when it comes to policy issues out there, but we actually both have very close personal family members who are serving at the moment, and that brings us together certainly on these issues. I think that is fair to say, and I think the Congressman would agree with that. So I want to thank you for what you are doing here. In Iowa, we have a lot of National Guard members, not unlike Madam Bordallo in Guam, and we come together on issues all the time to work as hard as we can for those Guard and Reserve---- Ms. Bordallo. I have the most per capita. Mr. Loebsack. That is right. Reclaiming my time, at any rate, I am happy to hear, Mrs. Wheeler, in particular some of the things that are happening with respect to the Guard and Reserve. In the State of Iowa, we have 3,500 Guard members who are getting ready to deploy to Afghanistan and a number of them have had a number of deployments already, and a lot of us are very concerned, of course, about the families, about the children and about the spouses. In the State of Iowa the legislature and the Governor are trying to do some things with respect to spouses and employment, to try to deal with these multiple deployments and just a multitude of issues that come up with the Guard and Reserve. Again, active duty folks, they have certain specific issues. Everyone has the same issues--similar issues, obviously. General Orr, who is our adjutant general, he really is trying to place a lot of emphasis on readiness centers and armories as focal points for families for services and what have you. Health care, obviously another issue as well. I want to give you an opportunity, Mrs. Wheeler, just to elaborate a little bit with the time remaining on some of the things that you have been working on. I know you folks were wonderful in being very brief at the outset here, but I would just like to give you some more time to talk about what you are doing and what you think needs to be done for the National Guard families. Mrs. Wheeler. Thank you. I appreciate the time. We have seen a lot of support for our National Guard families in recent years, and we do appreciate Congress especially and the services stepping forward to help our Guard and Reserve families, whose challenges are different than our active duty families. We are seeing some innovative ways of helping. I mentioned a few in my opening. But there are some other things as well. There is something called Fort Rochester, which is a virtual community that is being stood up and I think it is a way of being able to support families. This is under the Army program. And I think that is very helpful to not only think that it has to be brick and mortar, that how do we get to our Reserve Component families? They do not necessarily live in the same geographic area. Like I said, many of them live in rural areas as well. So thinking in more in terms of how do we support them. There is been a lot of things in recent times. Some of the things have been in like the joint family support program, assistance program, the JFSAP. That has been very helpful as well. We have also seen the Joint Services Support, which is something you can go to online. A lot of these things are Internet based, but we need to remember we need to have touch points with families. It can't all be through the Internet, and we need to make certain that we are giving them that type of care. Military OneSource has been tremendously helpful to be able to have time for families to be able to talk with one another and to reach out and have that behavioral health support that they need, especially for our children. We are seeing that with our Guard and Reserve children that they are-- with our RAND study that we went through we are seeing that they are experiencing the same types of things, but it is very important for them to understand that they are a military family also. And in the beginning of this war, many of our Reserve Component families did not feel like military families. They do now. And we need to make certain that we are supporting our children and the caregiver. We have also realized that when the caregiver has the support they need, then the family does better, not only during the deployment but during the reintegration period as well. Mr. Loebsack. Thank you. And just to finish up, I couldn't agree more with what you are saying, and certainly as the Guard and Reserve become an increasing operational force, they are part of the military in that sense, very much a part of the military. So thank you very much. I appreciate that. Thanks to all of you. Thank you, Madam Chair. And I yield back. Mrs. Davis. Thank you, Mr. Loebsack. I want to turn to the behavioral health issues a little bit, and I know Dr. Cohoon--I think all of you have referenced that in some way. But one of the concerns that you have expressed is that while families see that their loved one in theater may be getting some support that the families, when they are trying to get appointments or trying to access some care, are having some difficulty. Is there a way that you can perhaps--if you want to clarify some of those concerns and what you would suggest. I think you have mentioned the fact that we have a lot of family members who might like to develop the skills to be part of the force of behavioral health specialists that are serving the military. But short of bringing those people into the fields right away, what do you think that we need to be focusing on? Compassion fatigue, you have mentioned, creating burnout. What is it that we should be focusing on? I might also ask you as you answer that question, whether you think that we have done as good a job as we should be in integrating with Veterans Affairs as well? I think there is a real lack there in terms of transition care. And I will be perfectly honest, I am not sure that we do as good a job just here in Congress in terms of integrating some of those discussions, but I also feel like there could be something more that you might suggest in how we can better work with the Veterans Administration to answer the needs of many of our families in transition. Dr. Cohoon. Thank you, Chairman Davis. In the beginning of the war, we really didn't have that large of a robust network, especially for mental health providers. What were in the military treatment facilities (MTFs) actually would forward deploy and then that left a gap that was in the MTF, but we really didn't have that large of a network in our civilian option. Plus there is also a general shortage of mental health providers across the country. Now that there has been added funding both for DOD and VA, they have been able to bring more providers on board as far as in the direct care system, but sometimes they don't necessarily understand our culture. It takes a little while for them to learn about military life. That happens too in our civilian network the same way. As the network becomes more robust, we need to make sure that the mental health providers that our families are exposed to actually understand our population and our culture, and that would make things a lot easier with them. Those that are forward deployed, our mental health providers, we need to make sure that we are taking care of them also, that they have time, dwell time, so that when they do come back from theater they actually have time with their families to reintegrate, and then when they come back as far as to help us that they are ready to help us so that the provider themselves has the opportunity as far as to recharge their batteries, and a lot of times we are not seeing that. With the mental health integration between DOD and VA, that is what keeps me up at night. That is what scares me the most. Because basically when the military service member decides to leave the military--Admiral Mullen has talked about assessing the service member to make sure they are ready. We need to assess the family too to see how they are doing because once a service member transitions over to the VA status, depending upon what is going on, the family may not qualify for a lot of different services. They can buy COBRA so they could keep TRICARE for 36 months. They can use the Vet centers. But for the most part, a lot of opportunities for them and access to care goes away. When we are looking at funding for both DOD and VA, we are maybe taking providers from the state health agencies which is maybe where families end up going because they no longer have health care coverage; so we need to make sure that all the systems are working together because we are not fighting over the same resources since we have a shortage. Mrs. Davis. I believe that we are supposed to be looking at that as a result of the last bill that went through, and I am just wondering whether--have you had any sense that that is moving along at all, in the VA? I think there was an authorization to look at these issues further than what we have done in the past; is that---- Dr. Cohoon. Right. We appreciate any time that we are going to take a look at a program to see how well it is working or not working, and the VA is stepping up to the plate as far as wanting to bring in service members and their family when they are still active duty. We call it upstream. Then when they come in, then they are being assessed at that particular point and able to provide them services during that time. So that allows the family then to be introduced to the VA and to what sort of system of care is available and obviously we have seen the network increase tremendously as far as within the DOD TRICARE system. Mrs. Davis. Is there any sense that families would resist filling out surveys? We know that even the men and women who serve have some difficulty initially in wanting to be part of that for fear of not being able to go home or issues of stigma that seem to prevail. Have you heard anything? Are families really asking that they are surveyed and that there are forms that they could respond to that would suggest the level of their need? Dr. Cohoon. Stigma does exist even with our families for lots of different reasons. It is present in society as a whole, and so you are trying to break that particular cultural barrier on top of all of it. We really have been asking our families to be evaluated the same way that the service member is predeployment, during the deployment, and post-deployment just to see how they are doing. They were included in the Cohort Millennium Study, and we are looking forward to seeing what type of information we get from there. But we are really not getting the pulse of really how our families are doing. Our study did--had wonderful findings, but we are just scratching the surfaces and when the longitudinal pieces come out, we will be able to find out more and more information. But we have been asking that we start assessing how our families are doing. And even when the war winds down, we are also wanting to make sure that we have programs in place that we continue to, as far as we can, to bring more mental health providers on board and we keep surveying them on how they are doing. Mrs. Davis. What do you think is the best mechanism for doing that, then? I know we have telephone mental health where service members and perhaps you can tell me if their families as well would have the opportunity to access someone anywhere in the country who is there to be able to listen and to recommend some strategy, some treatment for them? Is that an important vehicle for that? How can we best assess---- Dr. Cohoon. Well, telephone mental health is great because it helps Candace's population, which is the Guard and Reserve. If it is nonmedical care, then it doesn't make any difference as far as where you sit as far as physically and where you are providing care where that individual sitting. But if it is medical care, we are looking at geographical barriers as far as licensing, as far as being able to provide the medical care, and we have been asking for that to be looked at to see if there are ways in which we can open that particular door up. There are some wonderful programs coming out. There needs to be some better education to our families as far as what the programs do, why they should be utilized. And especially the TRIAP program, there are some great opportunities there, but our families, I think a little bit with stigma, but also as far as not really understanding this new concept, that they haven't really embraced it as much as we would like to see done. Mrs. Davis. Thank you. Mr. Wilson. Mr. Wilson. Thank you, Madam Chairwoman. Again, thank all of you for what you are doing. And, Mrs. Wheeler, as a National Guard family ourselves, I had the privilege and opportunity of conducting premobilization legal counseling armory to armory for about 25 years, and as I look back, we were helpful but gosh, what is being done now and your organization has helped make it so much more meaningful and the family members truly understand now that their husbands or wives could be deployed overseas, not just in my state for hurricane recovery and relief. So thank you for what you do. Another issue that I am concerned about, the widows tax, the SBP-DIC offset. I am really concerned that a lot of people in our country do not know about this, and so if you all could explain how this is such a problem because I know it is, and any way that you can help us on legislation that is pending would be helpful too. Mrs. Moakler. Well, I think one of the major areas, as I mentioned before, retired service members choose to sign up for the survivor benefit plan and they pay a portion of their retired pay each month to provide for their spouse upon their death. So they have paid into that program. They may also be eligible because of wounds or conditions that they have because of their service. They may die from service-connected disabilities. Then their spouse would also be eligible for the dependency and indemnity compensation. Two different programs given for two different reasons. And that is why we believe it is unfair for the DIC to offset the SBP. Mr. Wilson. For many families we are talking about a thousand dollars a month? Mrs. Moakler. Yes. Mr. Wilson. And most Americans, you may be aware, are not at all aware, and people do understand what a thousand dollars means a month, particularly with children. So I hope you all keep raising the awareness so that good people like Susan Davis can make a difference. Also, another issue that I am concerned about is TRICARE. This is a terrific benefit for active duty, for Guard, and Reserve, but in some of the material that you all have provided to us you warn, which I think is correct, that this can be a hollow benefit and I am so concerned that be there are circumstances being created that can overwhelm the health care capabilities of our country. But on TRICARE in particular what recommendations do you have to make sure that this truly is a benefit that can be accessed by military families? Dr. Cohoon. We have been watching the Medicare reimbursement rate cut closely. As you know the TRICARE is tied--the payment is tied to the Medicare reimbursement rate, and as it drops down 21.2 percent we have been hearing from some providers that we may actually see them decide not to take our population, and this is not really the best time for us to be losing providers especially in the mental health field. We are also looking at our TRICARE contractors may be changing and we are looking at two out of three may possibly change. Of that that means that 66 percent of our providers will be up for renegotiation as far as either deciding to sign on for TRICARE or not. So you add that, the reimbursement rate possible cuts, and then national health care reform on top. We are wondering if given the reimbursement rate for TRICARE, if the provider will stay on board or not, and if they won't, especially in rural areas where there is a limited number of providers that are available to begin with, then you have a benefit, but then you are not able to access any doctors because they are not taking TRICARE. We hear on a regular basis that doctors are taking TRICARE, especially mental health, but when you call them they are no longer taking TRICARE patients. Mr. Wilson. And that is so crucial. I am the former president of the Mental Health Association; so this has been an issue that I care about and we have serious problems that need to be addressed. But we look forward to the suggestions that all of you have because I was struck by your comment of a hollow benefit. There are many people concerned about a free ticket, no show, that you have a card but nowhere to go. And we should be working together on how this can be beneficial and particularly in Guard and Reserve in faraway places. People commute--it is not uncommon--200, 300 miles across state lines to come to armories. So we have got a challenge. And I look forward to working with the chairwoman on this. Thank you. Mrs. Davis. Thank you, Mr. Wilson. I appreciate your raising that because I think we really do need to make certain that the providers are available and TRICARE has been actually recently successful in attracting physicians, but we remain concerned about that and the fact that I know that on a number of bases--I guess it is not necessarily just TRICARE--but where so many of the physicians are actually in theater who they had access prior to that and the community physicians have very much filled in a lot of those gaps. But you are suggesting that even though they may say they are taking patients, you are finding that that is not true. I think it would be interesting for us to know if you have some--I don't know whether it is necessarily statistics or even anecdotal information about that, it would be helpful for us to know and to have an opportunity to follow up as well. I would like to have a better picture of that. Dr. Cohoon. We have been using our Facebook as far as asking some information from those that have been following, especially with the Medicare cuts, are they hearing providers that are telling them that they are no longer going to be taking TRICARE? And I did ask the woman in our office, Bailey, that handles that, and we have pulled off some quotes as far as ``this isn't good, wonder how it will affect those of us as reservists.'' ``The civilian doctors don't want to take TRICARE before the cuts. Now it is going to become a real problem in certain communities.'' And another wrote, ``so many sacrifices to ensure your family is being taken care of and now this.'' So they--as I mentioned in our oral, there are--this has heightened our concern as far as access. We haven't heard that providers are actually walking away, but we do hear that when our families do reach out that even though they are taking TRICARE patients, they are just full up, or if they go to the behavioral health provider list, the same thing as far as calling them and finding that they are just not available. Mrs. Davis. So it is compounded when there is a shortage of providers and then a concern, and I think we are all working to be sure that there are no cuts that the physicians will need to be anticipating; so that is something that we are working on. Dr. Cohoon. And we are wanting to make sure that those that come back from theater have time to be able to regroup so that when they do come back to take care of us, they are able, they are full, 100 percent up and running so that they can take care of us. Mrs. Davis. Thank you. One of the issues I think you have raised with respite care, whether it is child care or it is respite care for a loved one who is caring for a wounded service member, as we look at limited budgets across the board, I am just wondering whether you are hopeful that we can allow for some reasonable respite care even though in many ways we haven't answered the initial need for child care itself or for care--for some compensation for those who are caring for a loved one. How did we try to balance those needs? Dr. Cohoon. I will talk about the respite for the wounded and then I will have Kelly talk about respite as far as for the child care. In the National Defense Authorization Act, you included a service member compensation but there isn't any added respite care that is in there. Others--there isn't any training that is in there. And as we are looking at seamless transition of care, we want to make sure that whatever starts while they are active duty, as we call upstream, that it is smooth and runs into the VA. And the VA has some programs, aid and attendance, home health, those types of things, but our services are keeping our service members a lot longer than they ever did in the past. So by the time the service member transitions along with the caregiver there has been years sometimes as far as going on. So if the VA is going to set up some types of programs which the House and Senate have passed which include respite care, include training and include compensation, we would want to make sure that these benefits--the caregiver can start giving those benefits a lot earlier along, so that by the time they have reached the VA we are not looking at someone that has been totally burned out. Because they have walked away from their employment, a lot of them. If it is mom or dad they may not have health care. They may no longer have a job. That is why we have been advocating for that particular piece. We understand that there is limited resources as far as funding. We are talking a small population that really could benefit from these services and we really want to make sure that the benefits we put together are seamless and they start upstream where the caregiver actually is recognized and starts their job and continues on without any bumps in the system into the veteran status. And I will let Kelly talk about the child care. Ms. Hruska. There are several available programs for respite care for caregivers when a service member is deployed. There are Guard and Reserve programs and programs for active duty both on the installation and for those who are geographically dispersed. Those programs are run through the NACCRRA, the National Association of Child Care Resource and Referral Agencies. In this year's NDAA, Congress called for a study to see if the program is adequately funded and if it is being utilized. We are anxious to see the results of that study and whether or not we think it is important---- Mrs. Davis. Do you know when that is supposed to be available? Ms. Hruska. I know GAO is just starting it; so we are hoping for it by the end of the fiscal year. Mrs. Davis. Thank you. Do we need to push a little harder? Ms. Hruska. That would be helpful. We would appreciate that. But we are anxious to see the results of the study to make sure that families know about it, are they utilizing it, and if there is an increase necessary, where is it required? Mrs. Davis. Thank you. Also, you mentioned, I think, Ms. Moakler, the summit on children's issues in May, and I am wondering what you hope is going to come out of that summit. Mrs. Moakler. Well, we hope to bring together great minds and come up with some action items that would pinpoint how we can take the programs we have and make them work better for both our caregivers and our children and also to see if we have missed any program. And we are going to have a two-day summit. First everyone is going to come together and come up with some action items. And then we are bringing more people in the second day to look at those and kind of kibitz and say, well, have you thought of this, have you thought of this, so that it is not just a one stop but that we pull as many folks as we can into the room to discuss this issue. Mrs. Davis. Is there anything about the RAND study that actually surprised any of you or that you felt really provided you with some additional information that you wouldn't have had otherwise? Mrs. Moakler. Well, I think around the office we call it the ``duh'' study. You know, it is something that we have all known through anecdotal evidence, but when we actually have the research to back it up that really helps us focus in on what needs to be done. Kelly, did you have something? Ms. Hruska. Well, as Kathy said, I just want to reiterate, I mean so many times we hear the anecdotal stories, and you asked us, well, how widespread is this? I think this gives us that statistical quantitative data to back up those anecdotal stories and that is very important. I think the longitudinal information is going to provide us much more information. And so we are anxious to share that with you when that becomes available. Mrs. Wheeler. One of the things I thought was striking was the fact that it is the total time of deployment, time apart during that period of time, and we are really looking at a three-year period of time. So our families are finding that the longer they are separated the more problems they are having. One of the other things I thought was fascinating was the reintegration piece for girls. Having raised a daughter myself and having had her father deployed, I think that was an interesting thing. So we have always been looking at deployment. Maybe we need to be spending a little more time on the reintegration, though we all know reintegration happens, before the reintegration happens, so making sure that the family understands what they might be moving towards, so giving them those types of support both before deployment and during deployment. That is what we are seeing with our Yellow Ribbon programs for our Guard and Reserve families, that that is helping them get ready, that they're learning skills as they move along. Dr. Cohoon. I would say looking at the fact that the caregivers--how their mental health is really affects the well- being of the whole entire family. And that brings us back to wanting to make sure that we really are assessing how our families are doing. You had asked me earlier as far as surveys, the Army, when I was over in Germany, they actually asked no matter what you are coming in for a series of questions to see really how you are doing. So it could be just as easy as that, that every time you have made a doctor's appointment, we just ask how you are doing. Mrs. Davis. One of the things that I picked up at a session recently with some of the wives, spouses of our SEALs, and Special Operations folks is that they had a lot of concern about additional help with homework and tutoring, and I was surprised. I was hearing that a lot. And I didn't pick any of that up on surveys necessarily, that there is such a concern on the part of the member who is serving that the kids may not be getting as much help, and obviously if you have several children, it is very hard for mom or dad, even if it is a single dad to try to provide that. Do you know whether that might be part of the focus? And I would really be interested in knowing if there is anything that we could or should be doing. I understand that there is a network online for some homework assistance and help, and I think maybe some of our families are aware of that. It sounded to me that a lot of them are not. Is this an area that you have explored with families and is there anything we can do to help? Mrs. Wheeler. I would be happy to answer that. One of the interesting programs that has been out for a while is called Tutor.com, and it actually is now being offered to all military families, which is wonderful. It had started with the Army and now it is being available for our military families. It is a 24/7 program. All of the--actually the tutors are trained and have certain certification in order to do this. We see this as a couple wins. Not only is this helpful for families, helpful for the service member in alleviating that concern; it is also an opportunity for spouses to look at portable careers. So we see this as a double edge, being able to actually help take care of our own which is marvelous. But this is a great program that has been moving forward. There is another program called the Scholarships for Outstanding Airman to ROTC (SOAR) program, which is offered by Military Impacted Schools Association. It is an online program as well. It is excellent and very, very helpful to families. So there are resources out there. I think a lot of it is making certain that they know they are available. The Tutor.com is new to all military families, and we have certainly been publicizing that and will continue to do so. So has the Department of Defense. And that is being funded for all families by the Department of Defense. So it is a great step in the right direction. Thank you. Mrs. Davis. That is fine. Thank you. I appreciate that. And just finally, I think Secretary Gates has said that there is a process looking forward to Don't Ask Don't Tell, that military families would be consulted. How do you think that would be helpful and what role do you all see playing in that? Mrs. Moakler. Well, first, let me state that the National Military Family Association has no position on Don't Ask Don't Tell, but we are pleased that the working group that Secretary Gates has appointed has been charged to look at the true views and attitudes of our service members and their families, and we are happy that they are going to look at both the policies that affect the service members and their families concerning eligibility for benefits and we hope that they will seek input from the broader military community, that they don't just focus on the gay and lesbian community but that they look at families across the board and our association has long promoted the need for support of all families during deployments and we feel that there are some families that are not getting the resources they need because of fear of disclosure, and so they are having to suffer in silence. Mrs. Davis. Thank you. I appreciate that. Thank you all very much. We are so glad you are out there. You are making such a great contribution. I know the military families are pleased that they have such strong advocates and we certainly want to continue work with you in every way possible. So stay in touch and let us know when you have some areas where you think we should give additional time and attention. Thank you very much for being with us. 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