>> ma'am, you're right. that was not a specific recommendation. the 45 recommendations are just a starting point. we have done a lot more since then and will continue to do more. i'm open and welcoming any suggestions and recommendations on what else we can do. you and i talked about this issue and i think it is an important one to find the right way to address. i want to do it in the right way. it gets back to this idea of feedback. >> my question would be why not? why something like that is it cost? is it personnel? i guess the follow-up question in terms of numbers and female m.t.i. and what you doing about that?

>> i will answer your initial question if i could and i will turn it back to ed. first of all, on speaking to the m.t.i.'s at lackland, a lot of people have spoken to them. ed, of course, the leadership and the team have all talked to them. the individuals that you talked to might not have been there. the number one i took away with the meetings with them is that those people, and the passion they have for this problem they feel the way i do. that's our air force. our military ought to be leading this effort. we have a structure, we have the ability to command, control, educate, and oversee, we have the ability to punish. we all the tools in place to be the role models for this. we owe the american people for that. >> general, please, time has expired.

please finish that answer for the record. >> mr. nugent. >> thank you, mr. chairman. my big concern, having been a sheriff and prosecuted and investigated sexual assault cases is the victimization. how do we deal with those victims and in particular, as an organization how does the reporting process go? sexual assault or sexual harassment don't always go hand-in-hand. they are different in certain aspects, but the reporting process. the commander makes the decision on whether it goes to a judicial process or if it doesn't?

how do they make that decision? >> very often it will be raised by a report to the equal opportunity office on base. the office conducts an investigation and there is a process that it goes through and then there is a decision made on what to do. is there something that you escalate that you deal with this? you make the decision after the promise is completed. it jumps into a process that is uc. you can report dectly to t inspecr general, you can through e chain of command, reporting is pt of

we havto get t the mi appcation becse witthey wt toove up to -- thugh the ranks and ey are aegar would be uagainst versus a fair apication. ifical for the vtims to without the worr you know, retaliation? them wita on-one briefin whais aed andhator when they gc military training. milaryfirsen w

repeat it again in technica pectations. i it is on the means we try over titakeme, seshldthey havee right way to develop a level of trust. the person that is conveying the information and in the system and how it will react. i think a second important way we're addressing this is basic training, is to provide other avenues and more of those other avenues for trainees to report. we have added more sexual assault response coordinators who will be out in the community. we've added more chaplains. again, someone who we hope they will feel maybe more comfortable talking to until one-on-one sessions.

more leadership in general, will be part of the equation. again, none of these are one point solution but part of a total package that we feel it has in our right direction. >> do your victims work hand- in-hand to try to heaven the victims -- work with the victims -- the job is to make the pros is as simple and painless as possible. follow include up through court-martial activity so they are removed from the lack of understanding and the poor communication which make theirs situation worse. >> does their mental health -- >> gentleman's time has expired. >> thank you, mr. chairman and

thank you for your participation. i've a letter dated the 16th to general rice from me they would like to submit. >> no objection. what year was that? >> last year. we all had a meeting about this document. we talked about 17,000 hours, we talked about 32 staff. general rice referenced 7,700 interviewed and not one of the victim, not one of the 50-plus victims at lackland was interviewed. 46 recommendations came out. but how can those recommendations be complete without first having talked to at least some of the victims? now, the letter i sent to general rice said those victims

were interviewed. i have yet to get a response from general rice. >> i don't think it can be complete. >> let me go on. the trainees we met with, we had lunch with them. they were 17, 18, 19 years of age. they were young, naive, and earnest. i thought to myself these are the age of my daughter. all these trainees are the ages of my daughter. my daughter would no more have the ability to say no to a military trainee instructor, who you are taught is the law. you do everything that training instructor tells you. there has been a lot of talk here today about all the things that are happening. what happened was the military training instructors instructed

these trainees to go to the supply closets and the laundry room where they were sexual assaulted and raped. we had two instructors who admitted they had sex with 10 of their trainees, each. these instructors were married. do you agree or not agree that con consent should not be part of this quotient. general rice said some of these were willingly engaged in sex with their m.t.i.'s. as i understand it, the m.t.i. should never be aloe with a trainee in a room. never alone. so, can a trainee willingly have sex with her instructor? your answer. >> i would never be able to

look you in the eye and tell you that no trainee of any age, we have trainees that are 32, 34 years old that go there the program, would be offer consent. let me tell you what i do agree with. an individual who is serving as a military training instructor who has a relationship like this with a trainee has no room now air force. >> i'm introducing a bill today that will basically say no longer can a consensual relationship between a trainee and instructor used as a defense. would you support that? >> i would have to ask the legal on the technicalities of that legislation. i would support you in an

effort to make sure someone who that is kind of relationship in a training program, it is unacceptable. >> that they are kicked out of the military? >> out of the military. >> a military expert professor hagel from yale said that the ucmj is something that would be recognized and it is similar to what is going on in the u.k. the united kingdom had a scandal like this in 2006. they created a separate unit. a separate unit that was staffed with experts in investigations and prosecutions within the military to handle these cases. so that the decision was not being made by the unit

commander. that was in 2006. in 2007, they found that good order and discipline stayed in tact, in fact, the unit commanders were relieved not having to handle these cases anymore. i would like to encourage you to speak with your counterparts in the u.k. to see how their system works and if we would be better served to move into a system like that. i yield back. >> i'm encouraged to hear you say there's a training session for the new recruits before they actually go to the m.t. think is very helpful. how do we get the recruits to fully understand or believe that reporting bad behavior will be supported by leadership and will not harm them? they can develop that trust and know that is the right thing to

do and have more conversation in their reporting and what might your suggestions be on that? >> very challenging. i've been through basic military training as well at the air force academy we do the same thing. i've been in that position and understand fully what these trainees think about this environment. and how challenging it would be, you know, looking back at my time and my experience to talk about things like this. sometimes it is very challenging. so as much as we want people to do certain things, i think we have to deal with the reality of the environment they are in and try to think about it from their perspective. part of this has to do with getting more feedback from trainees and looking at those barriers. i think the most important element or decision we can make in this regard has to do with trust. at the end of the day, if people don't trust either a

person or institution there isn't anything we can do in terms of train ling that is going to have them take that decision as what they perceive as perm risk. as we train our instructors how we relate to the trainees. how we train other people within this environment to relate to trainees, who we try to ensure that they have that level of trust and confidence -- within the system is part of the work we are undertaking. i don't have the answer today but i know that is a place i've got to get better at if i'm going to be more successful in the future. i think we can do a lot better but i'm not ready to tell you that i've figured it out.

>> mr. johnson. >> thank you, mr. chairman. a person who is training under a trainer and has a consensual, some might say sexual relationship or sexual intercourse with the boss. the boss might thing it is consensual but what is going on in the mind of the trainee is i need to do this in other words to get through training successfully. it is a duress -- it is a mental-type of situation.

it might not be forcible physically but forcibly mentally. that is why if there isn't one now, there should be a crime that makes it a per se violation to have sexual intercourse be it consensual or not between an instructor or trainee. i think that is probably something that mrs. tsongas has dealt with in her bill, which i fully support. now, a different situation between say, a former trainer or a trainer who formally trained someone who has made it through training and now that person is out of the dominion

and control of the trainer, then there could be a consensual relationship that does not equate to rape. -- so i'm not saying it at all times noncriminal. but let's just say that former trainer and a former trainee, -- a former trainer and a person that he trained -- he or she trained at a time previously, they are in a sexual relationship. but then the woman or the man -- the victim might say no, i don't want to do this today.

then it is forced on them. ok, so that is a classic rape allegation. classic allegation of rape or someone just took authority and imposed himself on a weaker individual physically. i've looked at the guidelines, the list of the recommendations and i see nothing about training military police in the gathering of physical evidence that would support the accused -- excuse me, support the accuser in making a allegation of an enforceable rape.

you only have one's word against the other. you have no other witnesses so you have to prove the case, prove it by physical evidence, a rape kit is what it is generally called. what is it that we don't have -- we don't make provisions for these types of cases. i think it is pretty typical in addition to the other sexual assault cases, harassment, nonphysical activities. why is it we're not dealing with this issue of rape and forcible sodomy and things like that in terms of police investigation and prosecuting ability to prosecute effectively? special trained

victim's investigators to this point. we just started a new class model on the army's c.i.d. class that was advised by outside experts to focus on that type of investigation. that first class just completed this week. we had outside experts to give us feedback that was objective. we will run classes through that course routinely. we sent 50 agents through the army's c.i.d. course before starting this one. we will further train our investigators to better investigate these actions. part of the reason we have trouble with people starting with prosecutions because the way they are handled it is so critical for them to stay with their commitment in identifying and prosecuting an assailant. >> january's time has expired. >> \[inaudible]

>> of those 17% of those women that reported the incident. my question is, i apologize, this i'm brand-new. this is my first hearing. i don't have the spence -- experience of those on the committee. i'm'm in the military and sexual assaulted how do i report that? is there a 911 in the military? what generates the report?

>> there's a hot line in the military. you can tell someone in your chain of the command. you can go to the security forces, going to to the base hospital or clinic and ask for help there. anywhere in that network is connected to the reporting mechanism that starts the activity moving forward. the problem is not that they don't know where to talk to, it is they don't feel comfortable reporting. sometimes they are concerned about getting in trouble or someone holding accountable for reporting. some are concerned about their family and friends finding out or their spouse finding out. some of them are embarrassed and some feel guilty about the incident. all of these things come together where people don't feel comfortable stepping forward. it is something we have to work constantly.

congresswoman.n easy answer, >> do we have in the military, the there something specific for this? this is crime. do we have a whistle blower protection in the military? am i protected and know as a female, if i'm a victim of a crime that i know i'm protected and i'm not going -- am i protected if i go and say i'm a victim of a crime, do we have a whistle blower protection? >> maybe. there is no hard, firm law that says you're protected physical you come forward and report something and everyone is going to make sure that you are not going suffer any consequence for the action you took. i think in the past, there were

many more accidents that people were held accountable for an event where they became a victim. none of the victims have been held accountable, made to feel like they are guilty of anything. that's the way it has to be going forward. we have a sexual assault response coordinator in every situation. they are trained on thousand handle these situations. as soon as we find out we have a victim, the victim is contacted and all the things we can help provide are available to them, not just law enforcement or investigative stuff. that is the last thing we want to worry about at the first contact. it is the personal care, the health care, the exam that is required. >> i appreciate that. when i call and report the accident. am i matched with -- is it gender to gender reports? am i reporting to a woman. >> no, that is not the case everywhere.

>> what is the ratio? i just don't know but what is the ratio of basic military instructors? military a basic instructor -- how many men versus women-wise? >> about 25%. air force wise it is about 19% women. >> thank you. thank you, mr. chairman. >> general rice, would you agree with me that the command chiefs with the commander set the command climate of a unit? >> i think command chiefs are an important part of that but i

feel it is fundamentally the commander's responsibility. >> and the command chief is the interface between enlisted foxes, the n.c.o.'s and the commander? >> certainly yes. between the commander and the airman within the unit. >> general rice, i would like to know how many female command chiefs do you have at lackland air force base and how many do you have in the recruiting command? >> i can't answer. i would like to take that for the record, please. >> general rice, can you tell me what the accessibility that a female trainee has to reaching out to a female command chief? >> no, i can't give you an exact answer to that question.

i do -- i would answer it this way. we have a number of females who are in the instructor or staff or supervisory or command positions. we are moving to a place where we have more females in those positions. basedt select commanders on they gender. i don't select command chiefs based on their gender. i do believe at the instructor level that the team that is responsible for a flight of 50 trainees should be include one female but beyond that we have not made another determination to make assignments of leadership positions based on gender. >> have you in any way, germ rice, empowered your command

chiefs to deal with this problem that seems to be happening -- or seems to have been happening? have you empowered your command chiefs to enact with this and if so, how? >> no. at my level i have not taken any direct action to specifically empower command chiefs other than making it mandatory that the rank of the command chief is no longer a senior master sergeant but a chief master sergeant. i believe you understand, based on you background the significance of that. i have to depend on a commander to use the resources that i have provided to him or her to maintain a proper command environment. it is up to that commander to use those resources whether it is a first sergeant, a command chief, a supervisor or anybody else, to use that combination of resources in a unique way

because every commander is different. so they can use the resources to maintain a good environment. i think it is problematic if i dictate how they put that team of people together. >> i would agree with you. >> and power the chief master sgt to enable the commander,

nco's understand the commander's intent. i will yield the balance. >> dr. heck. >> we have heard a lot of discussion about deployment and what is being done to encourage individual victims to report without fear of retribution. general rice, you talked about the train that goes on to impart the knowledge of how to report and what report. i can tell you as a military commander, and a well-trained programs. the problem is whether it is eo or preventing sexual harassment, it seems to be power

plants for people to glaze over. how do you judge the effectiveness of those training programs that are supposed be providing those initial entry service members were those that are only the front lines cleared through their annual recurrent trainees -- to make sure that they understand. i am an army guy. the train to cross the services is not resonating. these incidents continue despite this ongoing initial entry and recurring train. how do we assess the training programs that we have to try to stem the tide of these sexual assaults and associated sexual incidents? we add more.

all of the services do this. having an impact? expand those and get rid of the rest and wasting people's time that could be better spent in a different way tackling this problem. we have talked to experts advising us on this topic. one thing they told me that got my attention because i'm more interested in seeing if it works quickly continue if it doesn't, dump and try something else. he said you have to be more careful because some of those you won't know the impact until you give them time to work and it takes a while. the tricky parts are which ones can we stick with and the ones we stick with, we have to refresh and modernize and applicable workforce and scenarios on youtube. ted talks. the kinds of things that will attract them. that's scenario based training, not power point, go home and

look at it on the computer that.s0 will not help. that's the type of effort we're focused on. how do we energize this training and bring it in a personal level, not in the back of the room with 500 of your closest friends leaping through the latest sexual assault courage training. >> i'm encouraged by that approach and hope it works and you share with our sister services. i can tell you we have come far too of on training to time then standard. sitting in a classroom watching slides go by for 30 minutes regardless of the information being observed by the person in the chair. i applaud your efforts of doing assessment of what works and push that out across the services. thank you. i yield back, mr. chair. >> gentleman yields back. >> general welsh, i have a question i believe should be directed towards you. how were the victims involved in this investigation at lackland air force base

currently being cared for by the united states air force? >> thank you, ma'am. this is maybe most important question of the day. they're being careful as well as they possibly can. 59 victims were offered whatever level of support we could provide them. 57 accepted some level of instance, whether health care, counseling, legal assistance, whatever it might be. general rice can give you more of the details. types of things they accepted, i'm not fully aware with that. we tried to do everything we could. we offered new special victims' council. we offered that in advance of the initial capability date because we knew there were trials coming up and wanted to help them through that. some took advantage of that. anything we can think of to do to help them sadly after the fact we're trying to do. >> thank you. general rice, could you shed some light on why some of these victims chose not to exercise every opportunity to get care and counseling through the united states air force? >> i think there are a variety

of reasons. as i have gotten feedback. it goes from some of them do not consider themselves victims and so they have not wanted to have support. other 0s have considered the level of victimization, if you will such they don't require support. and others have made more full use of the support mechanisms that we have. so each one of these is a very individual case and individual decision. i'm confident we have made a good-faith effort to offer the support and conduct the investigations in a way that we have tried not to revictimize the victims. we tried to honor their requests if they said, you know, please i just want to sort of move on here. i do think, and it's something

i have talked to my team about, just as we found out oftentimes the initial answer to did something happen to you, no, if you reapproach the people in a different way over time that we can get them to develop a sufficient level of trust so they can be more accurate with us, that because a victim said no, don't need any help that we should go back at some appropriate time integral and reoffer that assistance because time does change people's perceptions of this. so we need to find the right way and time to do that. but i have that on my list of things to do here. >> we have had a lot of discussion here today about lack of reporting, on willingness to report incidents as they happen. i think right now every single airman is watching the situation and watching our victims to see how they're being treated and making decisions on whether to future report or

report on incidents that could be going on now or could go on in the future. that you're building a reputation about how you respond to these victims and it will determine your success on getting more accountability, on getting more reporting of airmen being willing to come forward and talk about what may or may not be happening. so just know as we work our way through this painful process and try to bring a resolution and improvement to it, there are a lot of eyes on you and a lot of eyes how we're caring for the current victims we have and we have an opportunity to do the best we can to take care of them. i have looked at some of the recommendation that's have come forward. i have a specific question about one or two, depending on how much time i have. one of the recommendations was a-19, shorten tour lengths to maximum of three years and do not allow special follow-on duty of assignments. will the m.t.i.'s that were perpetuating these crimes against victims there for longer period of times? did they have a longer service rate in their position that

they held? is that why this recommendation has been accepted? we did have some that with there are for longer then three or four years. typically, you won't serve as a military training instructor that long. you will move on to a supervisory position. so that recommendation is less about serving as military training instructor then it is consistent participation in the whole process, so the idea is you serve one and then you move on to something else. >> my concern was i read this and i assumed that some of the perpetuators, potentially were in these positions too long and maybe the climate within that position as they were there for a long period of time developed an attitude or environment where they felt as though it was more acceptable the longer they were there. i'mess that's the answer looking for is there's no consistency on length of time in that position from the perpetuators.

ok. thank you for that. i appreciate that. i yield back, mr. chairman. >> gentlemen, that concludes the questions we have for the first panel. thank you very much for the work you're doing. and we will excuse you and move to the second panel. thank you. >> what timing. this is the call for the last series of votes for the day. let's try to get as far as we can before we leave. we have on our second panel david lisak, forensic consultant.

chief master sergeant cindy mcnally. united states air force retired with the service women's action network. and technical sergeant jennifer norris, u.s. air force retired from protect our defenders. >> thank you, mr. chairman, ranking member smith and thank you to the committee for giving me this opportunity to speak to you this morning. i'm complain cal psychologist, researcher and forensic consultant for the past 25 years, i have studied rapists and treated and evaluated men and women who suffered sexual violence. for the past ten years i have worked extensively with the four services of the u.s. military and simultaneously in the civilian sector i have worked with dozens of universities across the united states and numerous law enforcement agencies and with state and local prosecutors.

my extensive contact with both military and civilian institution as cross the country provides me with a perspective on the problem of sexual violence i would like to articulate to this committee. sexual violence afflicts all nations and all societies. societies are not distinguished by whether or not they have a problem of sexual violence but rather by whether or not they actively and forthrightly confront the problem. same is true for institutions within those societies. it's perhaps ironic given the testimony have you been hearing today but in almost every respect u.s. military is doing more to confront sexual violence then any other institution in the united states. nevertheless, despite their efforts there are serious problems within the services yet to be addressed or yet to be fully resolved. it will require many, many years of sustained effort and commitment to resolve these problems and, therefore, many, many years of sustained scrutiny by this committee, congress more generally and by advocacy groups, which are some are represented here today. however, scrutiny and criticism of the military very often implies its problems and short

comings are somehow unique n my opinion this is not only grossly inaccurate, it also is a serious disservice to our country because it lets other institutions in this country off the hook. and in so doing puts men and women at those communities at far greater risk of sexual violence. specifically our universities have not confronted their problems of sexual violence with anything like the commitment shown in the services, there are a few exceptions. however, in no university have i ever seen the type of commitment from leadership, comprehensive efforts, sustained efforts tackling very challenging problems i have witnessed in the services. perhaps the most scathing criticism the military received has been focused on its short comings in prosecuting cases of sexual violence. again, i believe this criticism is necessary. however our country would be well served in the criticism of the military's prosecution record was placed in the context of the civilian prosecution of

sexual violence. with rare exceptions again there are enormous problems of the prosecution of nonstranger sexual assaults in civilian jurisdictions. nonstranger cases represent the vast majority of all sexual assaults. challenging case to investigate and prosecute and very few civilian jurisdictions made the necessary efforts to train their staffs to competently and effectively take on these cases. as a result many nonstranger cases are inadequately investigated and never even taken to a courtroom. many local prosecutors failed to prosecute the types of nonstranger cases that military prosecutors are now increasingly taking to court. services are making efforts and you heard some of these this morning, to increase efforts to response to sexual violence. one example and i think this was mentioned already, army develop aid two-week course to train investigators in state of the art techniques for investigating nonstranger sexual assault cases and 440 investigators now are being trained each year.

this is an example of one of the much-needed improvements that needs to be -- take place in the military's criminal justice response to sexual assault but it will take time for these improvements to take hold and be felt. and there's much, much more work to be done. improved training for investigators and military prosecutors must continue to evolve and it must be sustained. the services must confront the problem of junior litigators handling complex sexual assault cases far too early in their professional development. unhelpful biases and attitudes are still present among investigators, prosecutors and commanders and these must be addressed through a process of culture change that i think has been already stated, will be a permanent process. i hope that my testimony will not be taken here either as an apology for the military's handling of sexual assault or as yet another criticism of its efforts. based on my experiences working with the services, both very good and very bad things are still happening.

this is the reality and institution that is undergoing significant and meaningful change and i suspect it will be a reality for some years to come. it is impossible to average these good and bad things. they are simply both true. if the services sustain their efforts, if congress continues to provide clear-eyed scrutiny and crucially if congress provides the resources that the services need to sustain their efforts, i believe the united states military will lead the rest of the country in demonstrating what it means to confront sexual violence honestly and with sustained commitment. thank you very much. >> thank you. sergeant? >> good afternoon, chairman, and thank you members of the committee. i sit before you today having experienced sexual assault in the air force from multiple perspectives. first as a survivor of sexual assault as young airman. second, enlisted troupe -- troop who spent her career as

aircraft maintainer and supervisor who had 1500 groups as maintenance superintendent. i have had direct dealings with all of the personnel issue that's come with supervising people in today's air force and i will be sharing that perspective with you today. i enlisted in the air force in 1975 and was assigned to a woman and air force squadron at lackland air force base. at that time women trainees were segregated from men, both physically and in our course curriculum. following basic training i attended technical training where i began mint congratulation into -- my integration into the air force. it was there i was sexually salted by two of my instructors. i reported the incident believe my leaders would handle it and that didn't happen. i knew then would i never, ever report another sexual assault. in fact, a year later at my

first assignment, i was sexually assaulted again. i did not report it, nor did i ever discuss either of these two incidents until after i retired 28 years later and was being treated for ptsd. while many things have changed in the air force since i enlisted, the trauma of sexual assault has not changed. it feels like someone has reached into you and sucked the soul right out of you. it is traumatic and it is ugly. and for those of us who have survived it, we do so because of our strength and our will to overcome what could otherwise be a crippling episode in our lives. i remained in the air force, proud of my service, however. the reason i served for outweighed any single incident in my life. this was my choice. i also served alongside the nation's finest. in an air force where honor,

integrity and service before self are a way of life. our job as enlisted leaders is to defining the standard and make everyone absolutely understand we have no problem removing anybody in a blink of an eye if they cross that standard. and maybe that's where general rice and i somehow disagree. i believe the enlisted leaders are one of the most important people in the military to stop this epidemic. to me the sexual assault cases demonstrated what happened when leadership failed. sons and daughters at their very vulnerable. the power military instructors or t.i.'s have over airmen are perceived as absolute, turning young men and women from all over our country into airmen is a transformational process where the t.i. represented the sole success of that transformation.

turning to female leaders, when assaults have occurred is not always an answer. true yard stick for effective leader has nothing to do with their gender. i have worked with many men who have sent astringent work environment where all airmen are free from harassment and threatening workplace. n.c.o.'s in the chain of command have overarching duty to take care of their troops. doing what is right is genderless. i have followed closely the recommended actions in the midst of lackland disgrace and i have discussed some of these with swan and i had the privilege of talking to general woodward and a applaud her for her efforts in looking these issues. i believe the following steps that are being taken will have a positive effect on the training environment at lackland. i agree we should increase the number of female m.t.i.'s to at least the percentage that they are in the air force. all basic training students should be exposed to both male and female n.c.o.'s. this is after all who will be

leading them. increasing instructor-to- student ratio an absolute must. i was shocked find out that the t.i.-to-student ratio was roughly the same as when i went through basic training 35 years ago. a reasonable student to instructor ratio is education 101. i also agree with the requirement to raise rank of m.t.i.'s, technical sergeants and master sergeants are seasoned leaders and have a good deal of experience in identifying and taking action. however, a nonvoluntary t.i. assignment didn't work for and it won't work now. i have had troop that's viewed t.i. duty as death nell for their career. that needs to change to attract the type of people suited to train our next generation of leaders.

incentives to attract the best of the best are the answer, not nonvoluntary duty assignments. additionally, i do not believe women should be segregated. we train as we fight. one team. segregation in training did more harm then good in attempts to integrate us into the air force. we want to be viewed as airmen first and you cannot do that coming from a segregated unit. our own 0 history with racial integration should tell us that. larger solutions we need to look at integrating women completely into the armed forces. renew the combat exclusion policy. then we will be fully integrated force. being able to do the job should be the standard, not whether you're male or female. i believe that as leaders we took our eye off the ball. we enabled a climate where our troops became vulnerable and we can train and train but in the end, it is about leadership. we draw the line on what is acceptable behavior, define it and enforce it. i don't believe we could legislate leadership but we can

certainly have you hold our leaders responsible and legally liable for the welfare of their troops. that's an absolute must. in the maintenance career field where all of our leaders are passionate about doing what is right to protect pilots while they fly, our leaders need to feel as passionate about protecting our troops as they do the plying mission. you cannot minimize risk to zero but leaders can and better make sure they are there to make the right decision and do the right thing. our troops demand nothing less. thank you, mr. chairman. >> the vote is just about at an end. i have to recess the committee at this time to give everybody an opportunity to vote. we will vote and return. it will be looks like at least half hour. thank you.

>> we will call the meeting of the house armed services committee back to order. thank you for your understanding as we ran across to cast our votes and i'm sure other members will be coming back shortly. at this time we would like to recognize technical sergeant norris for her testimony. >> thank you for having me. i am jennifer norris. i'm an air force 0 veteran, wife to my dear husband lee. national advocate for the military rape crisis center and protect our defenders advocacy board member. protect our defenders is a place for survivors to build

community, amplify our voices, support one another and take collective action. it is with heavy heart that i appear here. i speak not only for myself but for the thousands of survivors whose lives were forever altered by this epidemic. a culture that punishes the victim is a broken justice system. i want to recognize the service members who have not survived due to murder, or suicide, and their families who are still waiting for answers. last august i stood outside these doors with fellow veterans and survivors. we delivered a petition asking to you open an investigation into the lackland scandal and its causes. there were 30 victims. now there are at least 59. since august the dod estimates

roughly 10,000 more men and women in uniform is have been assaulted. we hope this hearing is the start of fundamental reform. to remove bias, conflict of interest and opportunity for abusive authority that precludes justice. we ask this be a first in the series of hearings to fully explore the reasons lackland and similar abuses are occurring and what must be done to prevent them. as the restaurant express news put it, hearings look at the systemic hearing that's trial s can not and reinforce the concept of civilian oversight. both are needed.

core issues must be addressed. the committee should hear from current lackland victims and from independent experts on issues of victim treatment and military justice system. the cycle of repeated scandals, self-investigations and ineffective reforms must broken. because no victims from the current scandal have been invited to testify, i will share one of their stories from the local press. quote, a young air force recruit who said her basic training instructor sexually assaulted her testified after two months of obeying his orders, she was frightened to protest his advances in a dark supply room. the defense asked the woman if she resisted astacio's advances. i was too scared to, she

replied. tootimes when somebody's scared to talk, does that mean that they want to do something? a military judge found astacio not guilty of sexually assaulting the trainee. allowing the instructor to face a maximum one year prison sentence. her story is very similar to mine. when i joined, i was a 24-year- old, a small town girl with an idyllic childhood. soon i was raped and assaulted by superiors. two of the predators pled guilty to sexual assault. they were honorably discharged with full benefits. by not dealing with a culture that provides easy targets for

predators, we are hurting our military and our society. the predators often appear to be great troops, achieve high rank, are very charismatic and manipulative. but that is only part of the problem. the military justice system elevates an individual's discretion over the rule of law. too of on the commanders go -- too often the commander's go-to solution is sweep the problem under the rug and kick the victim out. often legislative reforms are inconsistently applied, unnecessarily encumbered or just not implemented. in my work as an advocate, it breaks my heart to see the same problems today that exists when

i joined. 16 years ago. sorry. 39% of female victims report their perpetrator was of higher rank and 23% report it was someone in their chain of command. the air force's lackland report and previous reports indicate a failure of leadership. how many more times must congress hear this before enacting fundamental reform? why didn't the air force

interview the victim to determine if they tried to report or feared reporting, and why? according to the d.o.d.'s own data, 47% of service members are afraid to report because of the reprisals that occur. forcesn't just an air problem. it is service wide. many secretaries of defense have declared a zero-tolerance policy yet recent actions challenge that notion.

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>> on behalf of my colleagues, i want to echo how much we appreciate the attention on health care in general being received as part of this hearing. i hope that when i share will assist this committee truly as you seem to get an understanding of the opportunities to address the gaps and barriers that currently exist in the mental health system. it has been echoed several times this morning. we know our country absolutely suffered a devastating loss of 28 precious lives. 20 in a sense, and a mentally

ill young man that did not get the care that he needed and his mother who did not get the care or the information that she needed. this tragedy along with those in colorado, arizona, they have thrown an invaluable spotlight on community mental health, mental illness, and this entire discussion. to work in this area of community mental-health is an extraordinary privilege. it is a tremendous responsibility. i have been fortunate to participate in a variety of perspectives as a critical incident responder, a faculty member, research collaborator, patient, and ceo. i have seen what the research shows. it affects everyone in treatment is effective. health centers do a tremendous job for the people we serve. we help people build a strong and healthy resilience individuals and strong and healthy resilience communities. there are several significant barriers and the gaps that make it difficult for local agencies to serve the safety that they were intended to serve by president kennedy more than 50 years ago. most significant is the availability of quality mental health services. we lack a federal definition of what services it should offer. many towns and cities do not have access to a continuum of care that covers the life span. since 50% of mental ellises

occur before the -- before the age of 14 and three out of four people experience the onset by the time they reach young adulthood, the lack of early intervention can have tragic and lasting effects. congress is encouraged to pass language included in the mental health act the finding that a community behavioral health provider must provide a a continuum of services across a life span. in particular, we wish to thank others for their tireless leadership. there are several ways to address the barriers for providing quality health services. banks to grant funding, we have been able to deliver home and school-based services within both urban and rural areas. these programs have been proven clinically effective and likewise 0 -- offset educational costs. increasing federal funding to effectively deliver prevention and early education services. congress could ensure that services to children and youth targets the entire family. these programs have been proven clinically effective and likewise 0 -- offset educational costs. increasing federal funding to effectively deliver prevention and early education services. congress could ensure that services to children and youth targets the entire family. research shows that programs that engage the whole family are the most effective programs. have adequate insurance coverage often becomes the barrier to

engaging the entire family. incredibly, not all states, counties and health centers offer formal crisis services. especially the services that are delivered seven days a week, 24 hours a day, 365 days a year. it would also require the prevention of these crisis services. technology also prevents another barrier. there have been tremendous advances of creating standardize communication guidelines. since mental health was left out of the act, we have not been able to fully benefit from these advances. strong bipartisan bills like those that have been introduced by representatives murphy, blackburn, and collins with behavioral health ip, this is what community behavioral health will be able to do. we can effectively share information for care including treatment plants with primary care providers.

we would prevent some of the drug interactions that occur because of a lack of shared information and hopefully prevent over prescribing. we can also effectively track outcomes overtime. there is a great need for integrating physical and mental health care. we hear a lot about the fragmented and broken health care system. the consequent at best is costly and at worst, dangerous and often deadly. people with serious mental illness on average a died 25 years earlier and then they're not mentally ill contemporaries. is it because of their illness? no, it is because of the impact of their home and work conditions. health centers are key to improving physical health care

by simultaneously lowering overall health-care costs. our expertise is part of the solution to meet the travel and of health care. reduce costs, improve health and quality outcomes. we're grateful that it launched primary-care and behavioral health integrated care programs. and since has launched 94 programs across the country. to have happened to land at center stone. and reducing the total health care costs by making sure services for behavioral health and physical health are provided at the same location. we have a substantial and complex task before us. we cannot solve these issues alone as providers. this is a watershed moment that the man's courage and action. everyone in this room shares

responsibility for the future of community and a mental health. health centers stand ready to work with you. elected representatives and officials to make a difference in the u.s. mental health care system. >> please proceed. >> thank you for always being there for us for mental health. it is interesting. as i hear the discussions happening around the room. i think you may be surprised about how many people are watching c-span today from around the country because they are so excited about the opportunity to discuss this matter in the kind of detail we are hoping for. i would like to share with you

that if i can take a video of today and the comments you all were making of their and comments made down here today, if we can encapsulate it and play it to the public, we would not have to be here today. i think people would be greatly moved by what was brought here today and what you're saying about our area of health care and how important it is to address substance disorder. there were several of you that said to tell us about what we might be able to do to intervene or what we can do earlier. i want to make sure to tell you that there are a couple of things that can be done. with the shortage of funding that has been in the area of mental health and substance abuse, the funding available has been focused on people that have already diagnosed conditions or already significantly ill. we need to ensure that we continue to provide care in those areas.

but we're having problems when we do prevention work in both physical and behavioral health area, often the funding is not available. you have to take it out of your own pockets to try to get some of the necessary prevention and early intervention services and support that they need to keep them from getting to that point. this is a problem in the area of medicare. today, we have not talked very much about the elderly. people think that when they get older, they will naturally be depressed and it is really not the reality. many people are aging in doing well but sometimes there will be depression or substance abuse disorders like anybody else. it needs to be preventive and also get the treatment. no. what is that we saw the opportunity for mental-health to

get out to the citizenry and be able to talk about mental health itself an increase their literacy and understanding and recognition of the signs and symptoms of common mental health diseases like a bipolar, major depression, psd, and anxiety disorders. it also provides a crisis de escalation technique for people that take the class. it helps you manage something where it is a splendid if there is a broken leg. had there is an action plan to get persons in distress referred to a mental health providers. the comprehensive program, in the wake of the summer that we had, we know about aurora and we had a major fire is this past year that a lot of people lost their homes and some loss of life.

it was one of the most depressing summers in colorado. we found that by using mental health first aid, people began reaching out for help themselves and help their family members understand more about what is going on with them and what is happening in the world around them. talking about the issues around a mental health, how they looked up and said, we need a program to help us identify things for family members and friends. let us tell you about mental health, first aid, and it became a real charge for us in colorado. we have also done training with department heads and middle managers and many state agencies. there is a consideration that all state agencies or state employees. they have trainers' and corrections officers. i can go on and on about the number of people that have received this.

i want you to know there is great news coming out of washington on this. the last week, the representative barber introduced the mental health aide act of 2013. as you know, he was wounded in a tragic incident. as they are recovering from their tragedy there, they have it on good authority that they will anticipate a bill with bipartisan support coming through the senate. i asked the consider supporting this as a committee and providing funding that we necessarily need in our community. what a tremendous opportunity to

be here today to speak on behalf of this area of health care. >> welcome, please proceed. >> thank you, chairman harkin. it is an honor to be here, and honor that we are getting this sort of focus on those of us that have experienced mental ls and addiction. i would like to address three topics today. first, stigma and discrimination that surrounds health disorders. second, the critical role of peer support and a new work force that promote recovery. and the importance of whole health. my body has been huge in my recovery.

those of the three topics i would like to address. first of all, i am recovering from bipolar illness and clean and sober 28 years. i can tell you and my peers can tell you that we fight to battles. we fight the illness and we also fight the stigma. we have a saying in our movement, what you believe about mental ls maybe more disabling than the illness itself. and yet, as a society, will largely remain ignorant about the signs and symptoms of mental ls and we ignore our role as supported community members to help those of us experiencing those illnesses. i was hospitalized three times in the '80s.

i fell in the category of serious mental illness. in the back of a deputy's car, is a humiliating experience. i spent the day in jail until family and friends intervened and got me help. i attempted suicide. it is humbling to be here today and have the chance to talk about this. the stigma is so significant that we often internalized it, it takes over our lives, not only the diagnosis, it becomes the prognosis that your life is over as you have known it. and today, i live a full and meaningful life.

i have a wonderful wife, i have a life in the georgia mountains. and the key to that was learning self management skills. those of us in recovery, we know about self management to stay well. peer support is huge, having somebody you can relate to. and also receiving services. i just want to say that learning about sleep deprivation and its role was huge for my recovery. the former director introduced me to that. i manage my bipolar illness largely by managing my sleep patterns. this new work force is certified

appear specialists. the 13 years i served on the management team, there are the fastest-growing work force in our state, we trained 1000, probably 12,000 across the country. we focus on strength-based recovery, we are able to deliver services. and research on the effectiveness of specialists have been so positive that in 2007, the center's issued guidelines for wanting to build your support services, proclaiming them as a model of care. research shows we have a unique ability to promote health. i warn that medicaid's focus on necessity makes it tough because we are strength based and we

look at unlocking hope and self management. it is stuck to find under medical necessities. the respite center is coming out across the country, early warning signs, you can go land and in georgia, we have three. you can spend seven nights surrounded by peers and is keeping people out of hospitals. we're having tremendous success of the department of justice settlement. this is a service that we had that is really starting to pay off. addressing the mind, body,

health care. there can be no health without mental health. we cannot care for people with addiction disorders without addressing the existing disorders. research indicates people with severe mental ls that serve the public health care system have an average life expectancy 25 years less than the general public. we have heard that already. i just want to thank samhsa for offering basic primary care screenings and referrals as part of primary care behavioral health integration programs. care managers, care specialists, and other professionals now working at 94 sites for a weight gain, and blood levels, cholesterol, and although data is still being collected, early results indicate this program has been successful helping people with behavioral health

conditions maintain and reduce their weight, cholesterol, blood sugar, and other risk factors. i urge the committee to support this grant program. in closing, i would like to say that after three decades of experience, it has taught me that the greatest potential for promoting recovery comes from within the individual. and with the support of family and community, my recommendation is to drive this potential, but in the center of all services and building on the strength and support. >> i think your testimony really does summarize what we are all here about today. providing the kind of interventions and support so people can successfully deal with an ls does likely deal with

every other illness and you are a prime example of that. from my limited experience, i could not agree with you more. the most important element, it comes from within and how we build that system. we talk about providers for support and tell you is extremely important. self management skills need to be taught. sometimes it comes from just a drug and it also recognizes and kind of get back to dr. vera on this. they are intricately intertwined. at the risk of practicing medicine without a license, i have been involved in this for

30 years now. from this standpoint, i think we have adequate data to show that so many physiological conditions have their genesis in psychological conditions. and we attempt to treat the physiological conditions. and sometimes it makes it even worse. we have a hearing last year on pain. all the pain clinics that have come out.

we had therapeutic preschools and every one of our health since health centers -- health centers. the schools were there to do with the most honorable children with whom we were seeing early indications of the onset of severe mental illnesses. those children we have referenced several times today. very few of those programs exist. we are fortunate to continue the program. it is not in the classroom anymore because that model was

no longer affordable. community mental health care has been subjected to a forward state of commoditization. as we move from medicaid programs to manage medicaid programs, our system is looked at as a commodity. our systems are analyzed to their smallest view to the nickel to the dollar for differences in choosing who the what themay be, ma array of services are. as the requirements dropped, those preschool programs were lost. we took our program and move it into a community. we were able to serve about 48 of those children per year. it was a high-cost program. the company had a hard time understanding what its role was. they were also receiving vital

educational services. let us remove these barriers that often times do not allow us to bring our systems together -- education, from justice, mental health -- in a cooperative way for the sole purpose of addressing our healthcare crisis. we spend too long are going over what part of the day education should pay for ursus what part of the day medication be paying for we have to address those immediately. >> was that part of the healthy children initiative that we had back then? >> yes, sir. >> that was 30 years ago. my wife was the head of that.

the deputy was marguerite who runs america's promise until we --my time is up. if there is one thing we could do that could change existing law or practice to spend money we now spend better, is there one thing you would like to briefly mention? >> i would like to make a recommendation that you allow the services that you currently pay for could be opened up to provide more services at the front end to provide more prevention, early intervention, support your services and to let the creativity of this country and how we move forward in other areas of healthcare to answer into behavior healthcare and allow us to do the right thing.

>> was there any other common? >> we keep talking about access and the shortage of psychiatrist, especially child and adolescent psychiatrists. we have been providing services since 2002 in the state of tennessee. no services are getting out to counties where we cannot hire fisher since -- physicians. it is 2014 as we sit here today. we need to bring -- align our payment strings with our current technology. we are not permitted in tennessee to provide tele- counseling services. i can provide tele-psychiatry. and work alongside a practitioner into medication

management. i cannot provide counseling services remotely through tele- health and get reimbursed. it is 2014. we have 12 years of experience on the psychiatry side. we cannot seem to move out of the current limitations around the services. >> thank you, mr. chairman. thank you, you all for your testimony. you know in your written testimony there are a number of barriers to access to children's mental health services, specifically you recommend. funding streams that encourage centers two inch - to partner with community organizations. i am introducing a bill called the mental health in schools

act. it does that exactly. by providing grant funds for schools to partner with mental s.alth sistecnenter >> thank you promoting that go forward. it is rather simple. we know that most of the disorders we see in children are identified first not as most of us would delete in the office of ap attrition or their family practitioner. but instead by their school teachers. some as early as preschool teachers who see this behavior. they are well trained in normal child development. they typically know what is expected of that age group. when they see unusual and bizarre behaviors or troubled children, they need to bring that to the attention of professionals.

those teachers have the competencies to help us identify those children who need early intervention. we are in 160 schools, currently in tennessee. those are partnerships that work. i have therapist in those schools providing the care that you are outlining. we need to get school-based services throughout the country. >> i was in minnesota. we had a roundtable there. one on integrating the schools with community mental health. you talk about how this is a family matter. we have three mothers testify whose kids were turned around completely to the good.

because the school system had integrated their system with community health and they had a mental health partner who took their case. we had one woman there. she was 26. she had a-year-old child who had been completely turned around. she was a single mom. she was not a wealthy woman living on 5th avenue. this woman have such joy. in describing her son who have been completely turned around. he was diagnosed with as berger's.- well as

we had two moms there. this is a family disease. i wrote two movies 20 years ago on the family disease of alcoholism. thank you for your testimony. congratulations on 28 years of sobriety. when i was doing the research for that, i was talking a lot to rehab counselors. dr. hogan, i want to ask you about this -- the shocking ignorance of general practitioners about alcoholism when you talk about -- the teacher is -- pretty attrition's -- pediatricians but they do not know about this is pretty remarkable.

integrated care is so important. it is something we do pretty well in minnesota. we have accountable care organizations. they have been pioneers. have we gotten better at this? >> thank you. i want to comment very briefly on your point about children. the senator has been closely

connected to and followed an extraordinary national program for young people who have got a developmental disabilities. if you have got a significant developmental disability, you are basically entitled to some care for your family. we have an average wait of nine years until we find out about it. this is of profound importance. training around these conditions, there is too much they have to cover in medical school. but it is not a problem that can be fixed by draining doctors better. primary doctors thought 7, 8, or 10 minutes. the only way this care can be delivered is if one of our types is parachuted into that practice. if the patients, as a screen in the waiting room, the doctor can then say, i see you have

concerns about sleeping and you are feeling depressed. i would like to ask mrs. jones to come in. she can then spend the time it takes to talk through the symptoms. these programs that go under a rubric of collaborative care, there has got to be a team approach. that can be thwarted by two things. i will argue in a way that may seem reversed. if you keep the insurance plan and only pay it through mental health specialists, it will not help the primary-care doctor. if you give it to the mainstream insurance plan and do not make the measure it, did you ask about depression? did you start people on treatment? did they improve? unless we do that, we cannot get results, either. i will say as important as it is, it is less critical now than

figuring out how to crack this problem of primary care. they have got have training -- >> i see a lot of nodding. there are primary care physicians who do not understand that the terahertz and do not understand they are seeing something that is really comes from something else. i am way over my time. >> thank you for being here today. there is a part we have not talked about.

millions of people who have serious mental health issues on not seeking care. you have talked in different ways about why that is so. you are describing different parts of the animal. we talk about stigma and why people do not ask for care. how we might deal with that with pure specialists, community health care centers, and doctors' offices. we talked a little bit in the early panel about research, so we get better treatment, how we get better outcomes at lower costs. the one i want to focus on, all

you just said the cost of mental illness now outstripped the cost of cancer in our country. we do not pay attention to it. hopefully this will set the stage for a lot of good bipartisan work and integration here of this committee looking to what we need to do to provide an integrated model.

in this new health care regime we seem to be embarking on in the near future. i thank you very much. i am certain our staffs or us will be in touch with you. for further enlightenment and suggestions. and recommendations you might have. senator? >> i want to thank the senator for this and the witnesses for coming. i look forward to following up. this is a committee on which we can have a very profound differences of opinion, when we are talking about new laws, new spending, new policies, but it seems to me a lot of what we fail to do is look at what we are already doing and ask people who are doing it, how can we take the programs we have got and the money we have got and make it easier for you to do what you need to do?

you have given us a long list of things today you have suggested that would improve your ability to identify the person to provide the help. while we may argue about some things, there is no need to argue about those things. we can work together and i would look forward very much to that opportunity and your specific objections about laws, regulations, and practices you think ought to be changed. we will see if we can do this in a bipartisan way. >> thank you. i request the record remain open

for 10 days for members to make additional statements for the record. thank you all very much in the committee will stand adjourned. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013] >> today the alliance for health reform holds a discussion on health care costs. they will look at the impact the affordable care act could have on future costs. live coverage at 12:15 p.m. eastern on c-span. >> we have created a platform that we call digital health feedback. the main components are and ingestible sensor that turns on when you swallow it and communicates through your body. it sends information through a

wearable patch and collect information about the medicines you swallow. quite a lot of things what we call a panel of physiological wellness metrics. it communicates with a cell phone you carry. it enable us to process it and send it back to you as an application to manager helalth. >> we have had all of these changes over the last five years. we are poised to make some great leads in these complex diseases. our understanding of cancer has dwarfed the last 25. the next 10 years will take us into amazing advances. >> the latest developments from this years ces consumer electronics show tonight at 8:00

>> this week on "q&a," washington d.c. metropolitan police department chief cathy lanier is here discussing her career. >> cathy lanier, what is the toughest part of being the chief of police? >> it is really not a tough job. the toughest part in the first couple years is getting used to the press. that was a challenge. other than that, sometimes, a little bit of politics. being a police officer is what i have done my whole adult life. being a police chief is not that much different. >> how many officers do you have? why is the press difficult?

>> it is washington d.c. everything is national news. some of the little things go viral in the press. it is sometimes puzzling why those things are of such interest and for so long. it is learning how to manage that constant beast, that everyby