According to DOJ officials, there are three key  VAWA authorized grant programs administered by DOJ’s Office on  Violence Against Women (OVW) that can be used by grant recipients to  fund or train sexual assault forensic examiners. Department of Health and Human Services, Indian Health Service,  “Chap. We refer to STOP subgrantees as grantees throughout this  report. DOJ officials told us that funding from additional DOJ grant programs may  be used to fund, train, or support the training of examiners, though  officials stated that the use of such grant funding for these purposes is  limited. Most States Had at Least One Grantee That Used Federal Grant Funds to Train or Fund Examiners

In 49 states, at least one STOP, Arrest, or Rural Program grantee— including STOP subgrantees—reported using federal grant funds to  provide training for sexual assault forensic examiners in 2013, the most  recent year for which complete data were available. Grantees in 49 States Used Federal Grant Funds to Provide a Variety of Training to Examiners in 2013

In nearly all states in 2013, at least one STOP, Arrest, or Rural Program  grantee reported using federal grant funds to provide training for sexual  assault forensic examiners in 2013. Specifically, in 2013, approximately  227 grantees in 49 states reported using grant funds to provide training  for over 6,000 examiners. Based on interviews with grantees in some of our six selected states and  a review of grantee progress reports submitted to DOJ in 2013, the type  of training that grantees provided for examiners ranged from  comprehensive examiner training and certification to training on specific  topics that enable examiners to improve their response to victims. The extent of examiner training efforts supported with STOP, Arrest, and  Rural Grant Program funds varied by state. In half of the states (26), fewer than 100  examiners received training and in 12 of these states fewer than 25  examiners received training. Grantees in 26 States Funded Examiner Positions in 2013, and Grantees in These States Funded Less Than One Position on Average

In half of the states, at least one STOP, Arrest, or Rural grantee funded  examiner staff positions in 2013. Nationwide Data on the Availability of Sexual Assault Forensic Examiners Are Limited; Officials in Selected States Reported a Need for Additional Examiners

According to our literature review and the experts we interviewed, only  limited nationwide data exist on the availability of sexual assault forensic  examiners—that is, both the number of practicing examiners and health  care facilities that have examiner programs. However, such  data may also present an incomplete picture of the availability of  examiners. For example, coalition officials in Wisconsin told us that  nearly half of all counties in the state do not have any examiner programs  available, and coalition officials in Nebraska told us that most counties in  the state do not have examiner programs available. In health care facilities where examiners are available, they are typically  available through hospitals on an on-call basis, according to literature we  reviewed as well as all STOP administrators and coalition officials we  interviewed. In addition, among facilities that have examiners available, the number of  examiners available varies and may not provide enough capacity for  facilities to offer examiner coverage 24 hours, 7 days a week, according  to state STOP administrators and coalition officials we interviewed. Selected States Faced Challenges Training Examiners, Maintaining Stakeholder Support, and Retaining Examiners

According to state STOP administrators and state sexual assault coalition  officials we interviewed in six selected states, maintaining a supply of  trained examiners that meets communities’ needs for exams is  challenging for multiple reasons, including the limited availability of  training, a lack of technical assistance and other resources, weak  stakeholder support for examiners, and low examiner retention. In order  to address these challenges, state officials told us that they have  employed a variety of strategies, such as offering web-based training  courses or clinical guidance or support for examiners, clinical practice  labs, mentorship programs, and developing multidisciplinary teams within  communities that respond to cases of sexual assault. Officials in five of six selected states told  us that the limited availability of classroom, clinical, or continuing  education training is a barrier to maintaining a supply of trained  examiners. Officials in five of six  selected states told us that limited stakeholder support for examiners and  examiner programs, such as from hospitals and law enforcement, is a  challenge to maintaining a supply of trained examiners. Additionally, some hospitals do not pay examiners to be on-call. In addition to the challenges of limited  training opportunities, technical assistance and other supportive  resources, and stakeholder support for examiners, the physically and  emotionally demanding nature of examiner work contributes to low  examiner retention rates. Wisconsin  officials estimated that although 540 SANEs were trained over a 2-year  period, only 42 (less than 8 percent) were still practicing in the state at the  end of those 2 years. DOJ provided  technical comments that we incorporated as appropriate.
Why GAO Did This Study

In 2013, about 285,000 individuals age 12 or older were reported victims of sexual assault, according to the Bureau of Justice Statistics. Studies have shown that exams performed by sexual assault forensic examiners—medical providers trained in collecting and preserving forensic evidence—may result in better physical and mental health care for victims, better evidence collection, and higher prosecution rates. Yet, concerns have been raised about the availability of examiners. The Violence Against Women Reauthorization Act of 2013 authorized funding for DOJ grant programs that can be used by states and other eligible entities, such as nonprofit organizations, to train and fund examiners.
GAO was asked to review the availability of examiners nationwide. In this report, GAO describes (1) the prevalence and use of federal grants to train or fund sexual assault forensic examiners, (2) what is known about the availability of such examiners nationwide and in selected states, and (3) the challenges selected states face in maintaining a supply of examiners. GAO analyzed 2013 DOJ data on grantees' use of funding to train or fund examiners—the most recent full year of data available—and reviewed literature, relevant laws and DOJ documentation. GAO also interviewed grantees in six states selected based on several factors including population and geographic location, as well as DOJ officials, Department of Health and Human Services officials, and experts, such as health care association officials.

What GAO Found

Federal funding from three key Department of Justice (DOJ) grant programs can be used to train or fund sexual assault forensic examiners and for a range of other activities related to sexual assault, domestic violence, dating violence, and stalking. In 2013, at least one grantee in 49 states used such funds to provide training to examiners and at least one grantee in 26 states funded examiner positions. In 49 states, approximately 227 grantees or subgrantees—referred to collectively as grantees—reported providing training for over 6,000 examiners in 2013. The type of training examiners received ranged from comprehensive examiner training to training on specific topics, such as courtroom testimony. The extent of examiner training efforts supported with funds from the three DOJ grant programs varied by state. For example, in about half of the states, fewer than 100 examiners received training. In addition, in the states where at least one grantee funded examiner staff positions in 2013, grantees funded less than one position, on average. Approximately 75 grantees in 26 states funded roughly 50 full-time equivalent examiner positions in 2013.
On the basis of literature GAO reviewed as well as interviews with experts and state officials, data on the number of examiners nationwide and in selected states are limited or unavailable. However, officials in all six selected states told GAO that the number of examiners available in their state did not meet the need for exams, especially in rural areas. For example, officials in Wisconsin explained that nearly half of all counties in the state do not have any examiners available. In health care facilities where examiners are available, they are typically available in hospitals on an on-call basis, though the number available varies by facility and may not provide enough capacity to offer examiner coverage 24 hours, 7 days a week.
There are multiple challenges to maintaining a supply of examiners, according to interviews with officials in six selected states. These include:
Limited availability of training . Officials in five of six selected states reported that the availability of classroom, clinical, and continuing education training opportunities is a challenge to maintaining a supply of trained examiners.
Weak stakeholder support for examiners. Officials in five of six selected states reported that obtaining support from stakeholders, such as hospitals, was a challenge. For example, hospitals may be reluctant to cover the costs of training examiners or paying for examiners to be on-call.
Low examiner retention rates. The above-mentioned and other challenges, including the emotional and physical demands on examiners, contribute to low examiner retention rates. Officials in one state estimated that while the state trained 540 examiners over a two-year period, only 42 of those examiners were still practicing in the state at the end of those 2 years.
Officials described strategies that can help address these challenges, such as implementing web-based training courses, clinical practice labs, mentorship programs, and multidisciplinary teams that respond to cases of sexual assault.
DOJ provided technical comments on a draft of this report, which GAO incorporated as appropriate.