Military Child Care: DOD Is Taking Actions to Address Awareness and Availability Barriers
Published: 2012-02-03T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: About a million military servicemembers serve the United States while raising a family, and many need reliable, affordable child care. Paying for high-quality child care can be challenging for these families, so the Department of Defense (DOD) offsets costs by subsidizing on-installation child care centers and offering subsidies for approved off-installation care providers. Deployments related to the wars in Iraq and Afghanistan increased the demand for child care. The extent of military families out-of-pocket child care costs for those using subsidized care are not known, and families may face barriers to obtaining DOD-subsidized care. GAO was mandated to examine: (1) the out-of-pocket child care costs paid by military families who use DOD-subsidized care; and (2) the barriers, if any, to obtaining DOD-subsidized care, and what has DOD done in response.
To address these objectives, GAO reviewed DOD policies and guidance; interviewed officials from DOD, its contractor that administers DODs off-installation child care subsidies, and organizations that support military families; reviewed DOD fee data for school year 2009-2010 (school year 2010) and school year 2010-2011 (school year 2011); and analyzed child care costs for a random probability sample of 338 families using off-installation care in school year 2010. GAO conducted nongeneralizable discussion groups with military parents at two large military installations.
GAO is not making recommendations in this report.DOD generally agreed with the reports findings and also provided additional information on several specific points in the report.
section_title: What GAO Found
paragraphs: Out-of-pocket costs for military families who use DOD-subsidized child care are largely driven by policies that vary by service. DOD establishes income-based fee ranges for on-installation child care, but each service sets its own fees and discounts within these parameters. As a result, in school year 2010 the per-child costs that families from the same income categories paid for on-installation care varied by service and installation. For example, the monthly per-child cost for a family with an income of $50,000 could have ranged from $335 to $518. Families costs for off-installation child care through private providers are also affected by policy differences among the services. All services offer subsidies for off-installation care that are intended to make families costs comparable to those for on-installation care. In an effort to offer benefits to more families, some services use a fixed cap to limit the subsidy amount. In school year 2010, the Air Force and Navy capped their subsidies at $200 per child per month, and families in these services had higher average monthly costs for off-installation care than Army and Marine Corps families, and also had higher costs than what they would have paid for on-installation care. For example, on average, Navy families using off-installation care paid $87 more per month than they would have paid for on-installation care, while Army families paid $63 less. Other factors, such as the number of children in care, also contributed to families costs for off-installation care. DOD and the services recent policy changes reduced differences among and within services in families costs for on-installation care, and DOD plans to further reduce these differences in the next 3 to 5 years. While the effects of these policy changes on individual families costs for off-installation care vary by family, families in services with fixed subsidy caps will likely continue to have higher average costs than families in services that do not.
Military families face two main barriers to obtaining DOD-subsidized child care: lack of awareness and insufficient availability. According to DOD officials and based on GAOs group discussions, some families remain unaware of subsidized child care, particularly off-installation care, despite DODs efforts to provide information at pre-deployment briefings, and through other outreach efforts. Families who are geographically isolated from an installation, such as reservists and recruiters, may be less likely to be aware of subsidized care. The individual services have taken steps to increase awareness of DOD-subsidized child care, such as establishing positions for professionals who educate families about child care options. However, even families who are informed about DOD-subsidized child care may face barriers obtaining it due to a lack of available space at on-installation centers and a scarcity of eligible child care providers off installation. The shortage of on-installation child care spaces resulted, in part, from heavy deployment demands, and DOD has responded by approving construction projects that it anticipates will provide over 21,000 new child care spaces using fiscal year 2008 through 2010 funding. DOD and the services have initiatives under way to increase the availability of eligible off-installation providers. In addition, DOD is developing an agencywide system that will provide servicemembers a central place to request both on-installation and off-installation child care. DOD plans to pilot the system in the spring of 2012 and intends to market it DOD-wide to servicemembers once it is fully implemented. The agency is in the process of contracting for the development of a marketing plan.

section_title: Letter
paragraphs: About a million members of the United States’ armed servicesbalancing the demands of serving our country and raising a family, and  many need reliable, affordable child care. Deployments related to the  wars in Iraq and Afghanistan have increased the demand for child care.  Paying for high-quality child care can be challenging, so the Department  of Defense (DOD) subsidizes some child care costs for military families.  Families using DOD-subsidized care may pay less than they would pay  for similar child care in the private market. Specifically, DOD subsidizes  the cost of operating Child Development Centers (CDC) that provide child  care on most military installations, allowing these centers to charge fees  that are the same or lower than similar privately operated centers off- installation. However, if on-installation care is unavailable, DOD provides  subsidies to reduce the fees that military families pay for care of  comparable quality in the community (off-installation care). For example,  such subsidies allow servicemembers geographically isolated from an  installation, including members of the National Guard and Reserves and  some active duty personnel such as recruiters or educators, to obtain  DOD-subsidized child care. Although DOD subsidizes a portion of military  families’ child care costs, the extent of out-of-pocket costs are not known,  and families may face barriers obtaining DOD-subsidized care.   are  The Congress, interested in learning more about DOD’s financial  assistance for child care, mandated in the National Defense Authorization  Act for Fiscal Year 2010 that GAO report on a number of questions  related to this assistance. As agreed with your offices, we assessed out- of-pocket child care costs for military families and barriers associated with  obtaining subsidized child care. In April 2011 we briefed your committees  on our preliminary findings related to these questions, which are covered  more fully in this report:  1.  What are the out-of-pocket child care costs paid by military families  who use DOD-subsidized child care?  2.  What are the barriers, if any, to obtaining DOD-subsidized care, and  what has DOD done in response?
To address our objectives, we reviewed the child care fee policies set by  DOD and the services for school years 2009-2010 (school year 2010) and  2010-2011 (school year 2011), including the ranges of allowable fees  charged to families for on-installation care. Some aspects of the services’  fee policies, such as their methods of calculating subsidies for off- installation care, were not contained in written policies. We obtained this  information through interviews with DOD and service officials. We also  obtained data from the services on the actual fees charged per child  using on-installation care in school years 2010 and 2011. In addition, we  analyzed these costs for families using off-installation care for a random  probability sample of 338 families from all four services in school year  2010 based on family files maintained by the contractor that administers  DOD’s off-installation child care subsidies, the National Association of  Child Care Resource and Referral Agencies (NACCRRA). Because we  conducted our sample data collection in the spring of 2011, school year  2010 was the most recent school year for which data for a full school year  were available. This analysis allowed us to generalize our findings to all  families receiving DOD subsidies for off-installation child care in school  year 2010. In order to present data on costs for on-installation care that  covered the same time period as our off-installation care cost data, we  analyzed on-installation fee data for school year 2010. We also analyzed  changes to the on-installation fee ranges in school year 2011. We  conducted semi-structured discussion groups with military parents,  including parents who did and did not have their children enrolled in DOD- subsidized child care, during site visits to Joint Base Lewis-McChord,  Wash. (Army/Air Force), and Marine Corps Base Camp Lejeune, N.C., in  order to identify barriers to obtaining DOD-subsidized child care. The  information obtained during these visits is illustrative and not  representative of each service or of DOD programs as a whole. We  selected large installations that had a Guard and/or Reserve presence  and had significant deployment activity. We provided DOD with criteria  that they used to select parents for our structured discussion groups. We  reviewed relevant policies and guidance, studies, and surveys of military  parents, and interviewed child and youth program officials with DOD and  each of the four services, including officials at service headquarters and  installations.knowledgeable about DOD child care programs, and officials from  national organizations that represent military families.
We also interviewed NACCRRA officials, researchers  We conducted this performance audit from June 2010 through February  2012 in accordance with generally accepted government auditing  standards. These standards require that we plan and perform the audit to  obtain sufficient, appropriate evidence to provide a reasonable basis for  our findings and conclusions based on our audit objectives. We believe  that the evidence obtained provides a reasonable basis for our findings  and conclusions based on our audit objectives. For more information on  our scope and methodology, see appendix I.
subsections: section_title: Background
paragraphs: DOD has provided subsidized child care to military members and civilian  military employees for decades. Today, DOD-subsidized child care is  widely considered to be a high-quality model for the nation. A recent DOD  report said that the Military Child Care Act of 1989, which created DOD’s  current child care structure and was enacted in response to concerns at  the time about quality and availability of services, focused on assuring  high-quality services and expanding access through subsidies. DOD- subsidized care assists military families in balancing the competing  demands of family life, accomplishing the DOD mission, and improving  the financial health of military families. However, DOD-subsidized child  care is not guaranteed to all who need it, and the availability of such care  depends on demand and the services’ budgetary resources. DOD’s goal  is to meet 80 percent of the demand for child care. Table 1 shows the  primary DOD-subsidized child care programs that are available to families  in all four services, although a few other service-specific programs exist.  Most military families who receive child care assistance do so by using  CDCs or other forms of on-installation care.
Several additional subsidized child care programs have been adopted DOD- wide, such as programs specifically for injured servicemembers’ families,  and respiterather than regularly scheduled care. In addition, services offer several   and hourly care—both of which are intended to offer sporadic,  service-specific subsidized child care programs. For example, Army Child  Care in Your Neighborhood, available only at specified installations, aims to  increase the availability of eligible community-based child care providers and  Air Force’s Extended Duty Care offers child care during nontraditional hours  to support servicemembers working extended or additional shifts to support  the military mission. The services acknowledge that some families may also  use youth development programs—programs outside of School Age Care,  such as recreation programs—as child care, although these are not required  to meet the DOD’s standards for child care and they are not intended to be  used as such.
The Office of the Secretary of Defense (OSD) establishes eligibility criteria  for subsidized child care and provides oversight and guidance to the  services, which each administer their own child care programs. For example,  OSD defines the following groups as eligible for military child care programs:  active duty military personnel, DOD civilian personnel, reservists on active  duty or during inactive duty personnel training, and DOD contractors. fiscal year 2010, there were approximately 1 million servicemembers with 1.8  million children ages 13 and under, according to our analysis of data from the  Defense Manpower Data Center. According to DOD, its child care system  is serving about 200,000 children from birth to age 12, and NACCRRA  records indicate that in fiscal year 2010, about 25,000 of these children were  served in subsidized off-installation care. OSD specifies that first priority be  given to active duty military and DOD civilian personnel who are either single  parents or whose spouse is employed on a full-time basis outside the home  or is a military member on active duty. However, OSD officials told us that  they are in the process of revising this policy. The revision under  consideration broadens the range of those in first priority status, adding  surviving spouses of servicemembers deceased while on active duty, among  other groups.
DOD Instruction 6060.2(4.3). Reservists include members of the Reserves and the  National Guard.
OSD also sets standards for provider eligibility for DOD’s off-installation  child care subsidies. DOD requires that providers under Military Child  Care in Your Neighborhood, intended for longer-term care periods, be  nationally accredited, to help ensure they are comparable in quality to  DOD’s Child Development Programs, such as CDCs. According to DOD  officials, child care can be considered accredited under a number of  different national accreditation and state child care quality programs,  which help ensure that child care providers meet quality standards.  Operation Military Child Care is intended for families of deployed  servicemembers, and DOD requires that, at a minimum, providers be  licensed and inspected annually.
OSD sets allowable ranges for the fees that families pay for on-installation  child care at CDCs, within which the services must set their fees. In contrast  to private providers, who generally set fees based on a child’s age, OSD sets  fee ranges based on total family income. OSD sets two fee ranges—one  for standard-cost areas, and one for high-cost areas, or areas with high  market rates for child care. Installations in high-cost areas must pay higher  salaries to retain qualified child care staff, and are allowed to charge higher  fees to help cover these additional personnel costs. The services have some  flexibility in how they set their fees for on-installation child care within the  ranges set by OSD. For on-installation care, a family’s cost is the fee that the  service or installation sets minus any fee reductions, such as discounts for  multiple children in care. Other factors affect family-level costs, such as  family size and the number of hours that children are in care.
The subsidies services offer providers for off-installation child care are  intended to provide benefits comparable to those that families would  receive for on-installation care. As with fees for on-installation care,  however, the services have the ability to determine the extent to which  they subsidize the cost of off-installation care. The services contract with  NACCRRA to administer these subsidies, which NACCRRA pays directly  to DOD-approved child care providers. A family’s cost for off-installation  care is the portion of their provider’s fee not covered by the subsidy.
section_title: Military Families’ Child Care Costs Are Largely Driven by Policies, Including Subsidy Caps, Which Vary by Service
subsections: section_title: For On-Installation Care, Services’ Policies Resulted in Variations in Per-Child Costs
paragraphs: As a result of services’ policies, the per-child monthly cost of on- installation care at a CDC for families within the same income category  varied by as much as $230 in school year 2010, depending on their  service and installation (see fig. 1). However, the per-child monthly costs  for most families in the same income category varied within a smaller  range. For example, the per-child monthly cost for on-installation care for  a family with an annual income of $50,000 could have ranged from $335  to $518 in school year 2010; however, for families in this income category  at most military installations with CDCs, the per-child monthly cost was  within the OSD standard fee range of $335 and $413.
The services have different policies for setting fees within the ranges set  by OSD. In school year 2010, the Air Force, Army, and Marine Corps all  allowed installation commanders to set fees for on-installation child care,  based on factors such as local market rates for child care. Most  installations set their fees within the OSD standard fee ranges.  Installations in high-cost areas, however, could set their fees using the  OSD high-cost fee range, or by increasing the standard fee by the  percentage of their cost-of-living allowance, which sometimes resulted in  fees that were above the OSD high-cost range. In contrast to the other  services, the Navy set one fee per income category for all of their  standard-cost installations and another fee per category for high-cost  installations. In addition, the services have the discretion, within DOD- prescribed policy, to set their own policies regarding the fee reductions  they offer to families, which generally apply only to on-installation care.  For example, services may offer fee reductions for families with multiple  children in care, families with a deployed servicemember, families with  injured servicemembers, and families experiencing financial hardship.
section_title: For Off-Installation Care, Families in Services with Fixed Subsidy Caps Had Higher Average Costs in School Year 2010 than Families in Other Services
paragraphs: In school year 2010, families using off-installation care in the Air Force  and Navy, which capped the monthly amount of subsidy a family could  receive at $200 per child, had higher average monthly child care costs  than did families in the Army and Marine Corps, which did not have fixed  subsidy caps. Across all services, on average, military families paid  about $556 per month for DOD-subsidized off-installation care (see table  2). However, the average monthly costs for Air Force and Navy families  were $787 and $734, respectively, compared to $501 and $556,  respectively, for Army and Marine Corps families. In addition to fixed  subsidy caps, several other factors affected families’ costs for off- installation care, including fee rates charged by private providers.
Air Force and Navy families had higher average costs by other measures  as well. For instance, families in these services using off-installation care  paid more, on average, than the estimated amount they would have paid  for on-installation care (by 11 percent and 16 percent, respectively). In  addition, on average, Navy families’ costs for off-installation care were 12  percent of their family income, while the average Army family’s costs  were 8 percent of their family income. Air Force and Navy families also  paid a higher percentage of their private providers’ fees (the fee before  being reduced by the subsidy), on average, than Army or Marine Corps  families.
Families’ costs for off-installation care are affected not only by subsidy  caps, but also by the fees services charge for on-installation care.  Generally, the subsidy amount is the fee charged by the private provider  minus the estimated amount that a family would have paid for on- installation care at a CDC. For example, if an off-installation provider  charges $1,000 per month, and a family would have paid $600 per month  on installation, the subsidy amount would be $400 (if there is no subsidy  cap), and the family would pay the same amount they would have paid on  installation: $600. However, in school year 2010, the Air Force and Navy  set subsidy caps, or limits, on the per-child subsidy for off-installation care  in order to offer benefits to more families. As a result, some families in  these services paid more for off-installation care than they would have  paid on installation. In the example above, if the family was in the Air  Force or Navy, which both had fixed subsidy caps of $200 per month in  school year 2010, the family would have paid $800 per month (the  provider rate of $1,000 minus the subsidy of $200), which is $200 more  than they would have paid on installation. The Army also used subsidy  caps in school year 2010. However, in contrast with the Air Force and  Navy, the Army’s intention was that a family’s subsidy would only be  capped if they used private providers who charged rates above what the  Army considered reasonable for high-quality care in their local market.  The Army caps varied from $153 to $2,576, depending on a number of  family factors, such as total family income. The vast majority of these  caps were above $200, and over half were above $500. Thus, Army  families were likely less affected by their service’s caps than were Navy  and Air Force families, as suggested by the lower average costs of Army  families in our sample.
In addition to fixed caps, other factors also affect families’ costs for off- installation care, including minimum subsidies, family factors, and  provider rates. Three of the four services offered minimum subsidies in  school year 2010, which families received even if their off-installation  providers charged less than they would have paid on installation (see  table 3). Army officials said that they offered minimum subsidies to  encourage families living off installation to participate in DOD-subsidized  child care programs. Other factors that affect off-installation costs include  family income, which is a factor in the services’ subsidy calculations,  and other family factors such as the number and ages of children in care  and the amount of time that they are in care, which may affect how much  a family pays in fees to a given provider. The fee rates charged by private  providers, which are influenced by child care supply and demand as well  as the geographic location of the local community, affect costs for some,  but not all families. In the absence of subsidy caps, provider rates do not  affect costs, since the family’s subsidy covers the full difference between  their provider rate and estimated on-base fee. For families in services  with subsidy caps, however, the subsidy may not cover the full difference,  in which case families with higher provider rates will have higher costs.
Recent and planned changes to OSD and the Army’s fee policies will  continue to reduce variation in the amount families in the same income  category pay for on-installation care. In school year 2011, OSD revised  the fee ranges for the first time since school year 2005 to account for  inflation and increases in servicemembers’ incomes and to achieve a  more equitable distribution of fees for military families. Specifically, OSD  divided the top income category into four categories, increased the  maximum income for each category, and increased both the minimum  and maximum fees for all categories except Category I (see table 4).  Under the new fee structure, OSD set a single fee per income category  for high-cost installations, which all high-cost installations are now  required to charge.
The impact of these revisions on military families’ costs for on-installation  care varied depending on families’ service, installation, and income. In  general, however, the new OSD fee policy reduced the variation in the  per-child monthly cost for families in the same income category using on- installation care among and within services. For example, while in school  year 2010 the per-child monthly cost for on-installation care for a family  with an annual income of $50,000 could have varied from $335 to $518  (see fig. 1), in school year 2011 the per-child monthly cost for families  with the same income could have varied from $358 to $478 (see app. II,  fig. 4 for the full range of fees charged by the services in school year  2011). Costs for families with this income at most installations were within  the OSD standard fee range of $395 to $456 (see table 4).
OSD officials said that they are working with the services to transition in  the next 3 to 5 years toward a DOD-wide fee policy like the one currently  used by the Navy, with one fee per income category for standard-cost  installations, and another fee per category for high-cost installations.  According to these officials, the new fee policy implemented in school  year 2011 is the first step in this transition.
OSD’s changes to its fee policy and additional changes the services have  made to fee policies for off-installation care affect costs for some families  using off-installation care, but the extent of these effects is largely  unknown. The new OSD fee ranges affect costs for families using off- installation care, as well as on-installation care, since the on-installation  fee rates are used to calculate subsidies for off-installation care. In  addition, all of the services have recently made changes to their off- installation fee policies that make these policies more consistent in some,  but not all, respects. See table 5 for a summary of these changes.  Subsidy minimums are one area where the services’ subsidy policies for  off-installation care are not consistent, since Navy and Air Force families  receive a minimum of $10 per child per month, all Marine Corps families  eligible for full-time care receive $250 per child per month, and Army  families no longer receive a minimum subsidy. Given that the average  costs for families in our sample in services with $200 subsidy caps were  higher than those for other families, the average costs of Marine Corps  families using off-installation care are likely to rise with the  implementation of the Marine Corps’ $250 subsidy cap. Some Marine  Corps families, however, will see a decrease in their costs if they  previously received a subsidy of less than $250 per child per month. In  general, the effects of these subsidy policy changes will vary by family. In  particular, the effects will vary for families in services with subsidy caps,  because costs for these families are driven partly by private provider fees,  which vary considerably regardless of the services’ policies.
section_title: Limited Awareness of DOD-Subsidized Child Care Programs and Availability of Care Pose Barriers for Military Families
subsections: section_title: Even with Outreach Initiatives, DOD Faces Challenges Educating Military Families about Child Care Programs
paragraphs: Although DOD provides information about subsidized child care programs  through a number of sources, DOD officials and military parents cited  limited awareness of these programs as a key barrier to their use. DOD  uses many outreach methods, such as deployment briefings and other  events, brochures and ads, e-mails to servicemembers, staff assigned to  provide child care information, and Internet avenues, including websites  and social media. Figure 2 shows common sources of DOD child care  information.
DOD officials stated that while military families living on or near an  installation likely know about child care available through CDCs and  Family Child Care, they may not know about other on-installation child  care programs, such as respite care. Furthermore, both those living on or  near an installation and those living far from an installation may not know  about off-installation programs. For example, many servicemembers we  spoke with did not know about DOD-subsidized off-installation child care.  In addition, those who knew about the DOD-subsidized off-installation  programs had not always learned about them when they needed child  care. For example, two servicemembers we spoke with said that they had  learned about off-installation programs, but only through the community- based provider they were using without benefit of DOD subsidies. One of  these servicemembers said that he had used a community-based  provider for a number of months before the provider told him about the  DOD subsidy program, and this was only when he notified the provider  that he no longer planned to use its services because he could not afford  the child care fees charged. Also, families that learn about DOD- subsidized off-installation child care programs may not be aware of the  eligibility requirements of the programs. For example, officials at the  National Military Families Association told us that many military families  that heard about DOD off-installation subsidized child care believed that  the programs are needs-based, and thus assumed that they were not  eligible for them because their income was too high, even though the  programs are not limited to low-income families. Similarly, two military  spouses we spoke with incorrectly assumed that only those with low  incomes were eligible for such subsidies.
DOD faces a number of challenges to educating military families about  DOD-subsidized child care, particularly off-installation care. These  challenges include the large quantity of information servicemembers  receive during briefings, the timing of information provided, fewer  opportunities off installation to educate servicemembers about DOD- subsidized programs for those geographically isolated from an  installation, and fragmented child care application procedures. DOD and  the services have taken a number of steps to address these challenges.
Quantity of information received. DOD officials and an organization  representing military families told us that information on DOD- subsidized child care programs is frequently provided at pre- deployment or other briefings, but because these briefings are often  lengthy and cover multiple topics, servicemembers often do not retain  information about child care. In 2007, we reported that DOD had a  similar concern regarding briefings provided at mobilization sites and  demobilization sites, which DOD considers to be primary educational  tools. DOD officials said then that these briefings are often so full of  critical information that it is difficult for reservists to absorb all of the  details of its health care insurance program. In fact, several  servicemembers we met with noted that they tune out or become  overwhelmed by long briefings and therefore do not retain much of the  information, such as on child care.
DOD officials recognize this concern and said that they try to ensure  that military families learn about DOD-subsidized child care by  providing them with many opportunities, beyond briefings, to learn  about these programs. For example, because DOD considers  command unit leadership to be key to ensuring readiness, including  supporting spouses and families, DOD has taken steps to help units  provide child care information to their servicemembers and families  through unit contacts. Officials from all four services told us that they  provide information on these programs to these contacts, including  the unit commander and other unit staff designated to provide this  type of information to families. Two services—the Army and Marine  Corps—created professional positions within military units that are  responsible for supporting family readiness by providing assistance to  families, such as child care information. These positions also support  formal volunteer organizations tasked with communicating information  and providing education and support to military families. Although  the Air Force and Navy have not designated such professionals within  units, they have family services professionals outside of units who are  assigned to serve servicemembers in units. For example, the Air  Force has community readiness consultants and family child care  coordinators assigned to serve specific units and provide the same  type of support to families as do Army and Marine Corps unit-based  professionals. Both Air Force and Navy also support similar volunteer  organizations and efforts, such as Navy’s Family Ombudsman  Program. Many servicemembers we spoke with stated that these  family readiness professionals and volunteer organizations are helpful  in learning about DOD-subsidized child care programs, while others  noted that the level of assistance varies.
Each of the four services has taken additional steps to increase  outreach for these programs. For example, the Marine Corps  prepared a fact sheet on DOD-subsidized off-installation child care  programs, which includes answers to frequently asked questions  including updated information on program policy changes. The Navy  hired an outreach coordinator for installation and community-based  child care programs. Also, the Army and Marine Corps provided  resource and referral staff a “script” to ensure that staff members  provide consistent, specific information on DOD-subsidized off- installation child care programs. The Air Force developed a marketing  strategy including materials such as pamphlets and an  implementation guide for program staff, intended to provide  information on family child care programs to servicemembers.
Timing of information provided. Officials from DOD and groups  representing military families told us that information on DOD- subsidized child care is more likely to be absorbed if it is provided  when military families need it. Some servicemembers we spoke with  mentioned that they ignored information on DOD-subsidized child  care programs when they did not need child care, but were interested  in such information when they later needed this service, such as when  they became parents and had to return to work. One servicemember  said briefings targeted to parents-to-be or those with children of  similar ages would help overcome the problem of not getting  information at the right time. For example, without targeted briefings  about child care, not all parents-to-be learn about the need for getting  on waiting lists for on-installation care. On one installation we visited,  not all of the military mothers we spoke with had been advised that  they needed to get on the CDC waiting list, which was about 9  months, as soon as they learned they were pregnant. Those who  were not alerted said that they had to take leave to care for their  infants until they could find child care.
Services recognize the need for targeted information on child care  and have implemented education programs, such as those for  expectant and new military parents, and mandatory physical training  for postpartum servicemembers, both of which offer the opportunity to  educate participants about the need to get on CDC wait lists. Services  target child care information to military families in other ways, as well.  For example, the Air Force offers a sponsorship program aimed at  facilitating permanent change of station moves. Under this program,  Air Force servicemembers trained as sponsors welcome and assist  colleagues and their families who are new to an installation by  providing information on local services, which can include information  on DOD-subsidized child care options. One Air Force servicemember  we spoke with had a sponsor that had helped her find housing and  child care when she moved to a new installation. Other examples  include the Navy and Air Force’s new programs to market DOD- subsidized child care programs to military families, such as to  reservists who have children and have recently deployed.
Fewer opportunities off installation to educate servicemembers.  DOD estimates that two-thirds of those stationed in the United States  do not live on an installation and many of these families live long  distances from an installation. However, because DOD child care  programs have traditionally been focused on installations, more  information about DOD-subsidized child care, including daily exposure  to sources of child care information, is available to those living on or  near an installation. For example, installation outreach can include a  walk-in information and referral center and ongoing child care  publicity, such as on marquees on the installation promoting child care  programs. Also, military families that are geographically isolated from  installations are likely isolated from military peers that DOD officials  and several parents we spoke with cited as a source of child care  information. As a result, families of servicemembers who do not live or  work on an installation, such as recruiters and Guard and Reserve  members, may be less aware of DOD-subsidized child care programs,  including those that become available when they deploy. For  example, results from a 2010 Army Guard survey showed that many  Army Guard members were unaware of DOD-subsidized child care,  while most military families living on or near an installation are likely  knowledgeable about the availability of on-installation care.
Limited exposure to on-installation information about DOD-subsidized  child care may affect Guard and Reserve families to a greater extent  than active duty families that live remote from an installation. These  military families may often identify with the civilian, rather than the  military world, and thus may be less likely to look to the military as a  source of support. One reservist told us that reservists generally  assume that if they do not live near a military installation, military  services will not be available. Thus, many reservists might not even  think to ask about DOD-subsidized child care when they are activated.
DOD and NACCRRA have both taken steps to address the need to  provide more opportunities to educate servicemembers about DOD- subsidized off-installation child care. DOD implemented the Joint  Family Support Assistance Program to supplement and coordinate  family services provided by the services, including child care, target  military families geographically dispersed from a military installation,  and collaborate with community organizations to enhance the  availability of high-quality family services. The services have also  taken such steps. For example, the Air Force implemented an Air  Force Reserve web page on the Family Members programs, which  includes information on child care available to reservists. Marine  Corps officials stated that in light of the subsidy cap they implemented  in school year 2011 that will make subsidies available to more Marine  Corps families, they have taken additional steps to contact reservists  to educate them about off-installation program information, including  program changes and how to obtain access to programs. In addition  to hiring an outreach coordinator for installation and community-based  child care programs, the Navy is developing marketing and  communication strategies and webinar training specific to the Navy  Reserves in order to better educate reservists about DOD-subsidized  child care programs. The Army makes phone calls to families of  deployed reservists to ask what services they need, including child  care, and provides information and contacts for DOD-offered services.  Also, because Reserve and Guard members may turn to civilian  sources of assistance, NACCRRA officials stated that they asked their  members to inform those who identify themselves as military families  about DOD off-installation child care subsidy programs.
In addition to learning about DOD-subsidized child care, obtaining  information about applying for this care has also been a challenge  families face, because servicemembers must apply for on-installation  child care at different places than for off-installation child care. Also, for  off-installation programs there are a number of eligibility requirements for  the military family and standards for the community-based provider that  differ depending upon the program. Generally, in order to apply for on- installation child care, including CDCs and Family Child Care, parents  must contact the on-installation child care resource and referral office.  However, if on-installation care programs have waiting lists and the family  needs child care immediately, they must contact another entity, generally  NACCRRA, if they choose to pursue DOD-subsidized off-installation care.  For the most part, this process is separate from the installation’s resource  and referral office and the installation generally does not follow up on  each family’s success in finding off-installation care. Although NACCRRA  assists families in finding an eligible community-based provider, if  available, and applying for DOD-subsidized care, some servicemembers’  spouses and Guard officials found applying for the programs difficult. For  example, several servicemembers’ spouses stated that the website did  not provide clear steps on how to apply for DOD-subsidized child care.  Further, several regional Guard officials stated that applying for off- installation DOD-subsidized child care is complex because requirements  vary among programs, making it difficult to determine the programs for  which a military family may be eligible. Also, they noted that providers that  meet DOD’s requirements, which vary by program, are often not  available, especially for programs with more stringent standards and in  areas far from military installations. Additionally, several military parents  we spoke with said that because there is no one place to find child care  options available to them, particularly for off-installation child care, they  had to research these options themselves in order to find alternatives to  on-installation care.
DOD is developing a central system intended to enable eligible military  families worldwide, regardless of their service branch, to request military  Child and Youth Program services that meet individual child and family  needs. DOD officials told us that the system is aimed at helping educate  military families about DOD-subsidized child care by identifying programs  the family is eligible for based on information they enter into the system.  Such a system may help alleviate the problem of unclear information on  how to apply for programs and difficulties determining eligibility. DOD  intends to market the system DOD-wide to servicemembers once it is fully  implemented. The agency is in the process of contracting for the  development of a marketing plan which will include assessing marketing  needs and a strategy to market the system to users, in coordination with  the services, among other things. DOD plans to pilot the system in the  spring of 2012, and to begin full implementation of the system in the late  summer or fall of 2012.
section_title: Availability of On- Installation Care Is Limited but Increasing, and Eligible Off-Installation Providers Are Scarce
paragraphs: In response to limited availability of on-installation child care and eligible  off-installation providers, DOD and the services are increasing capacity at  on-installation facilities and in the community as part of their commitment  to family readiness. According to DOD officials, the increased demand,  due to high deployments and increased operational tempo, puts pressure  on the services, the Army and Marine Corps in particular. DOD officials  stated that CDC waiting lists are common and DOD officials told us that  Family Child Care home capacity is not increasing. As a result, many  military families may not be able to obtain on-installation care when they  need it. This is particularly an issue for families with children under the  age of 3, especially infants. To meet this demand, DOD is increasing on- installation child care capacity by constructing new CDCs that it expects  will result in meeting 80 percent of the estimated demand for military child  care by 2012. DOD anticipates that construction projects approved in  fiscal years 2008 through 2010 will add over 21,000 additional child care  spaces.
Military families that cannot obtain on-installation care due to wait lists  and those that are geographically isolated from an installation may be  eligible for DOD-subsidized off-installation care, but community-based  providers who meet DOD’s quality standards are in short supply. Figure 3  shows the circumstances under which servicemembers may be eligible  for DOD-subsidized off-installation care.
Providers under Operation Military Child Care must be, at a minimum,  licensed and annually inspected by their states, but according to  NACCRRA not all states have requirements to regularly inspect licensed  child care providers. Standards for providers under Military Child Care in  Your Neighborhood are even more stringent. Under this program DOD  requires eligible providers to be nationally accredited, but relatively few  child care providers in the United States are accredited. According to a  NACCRRA review,and 1 percent of family child care homes in the United States were  nationally accredited. Additionally, the percent of child care centers with  national accreditation varied from 2 to 47 percent among states.   in 2008 only about 10 percent of child care centers  DOD is taking steps to increase the number of community-based  providers eligible for DOD subsidies. In the near term, Army Child Care in  Your Neighborhood and Army School-Age Programs in Your  Neighborhood subsidize nonaccredited providers who are participating in  an Army quality improvement program. To help increase providers  participating in these and other off-installation programs the Army  established a full-time position to coordinate and manage community- based child care at selected installations, such as Joint Base Lewis- McChord in Washington. In addition, DOD is making more community- based providers available to military families who qualify for Military Child  Care in Your Neighborhood by allowing the services to waive the  accreditation requirement if it is determined that no accredited provider is  available to the applicant. Further, according to NACCRRA it obtained  agreements from all but three states to inspect licensed providers  annually on a case-by-case basis so that military parents using these  providers can receive subsidized care. Even with these efforts, DOD  officials told us that some military families potentially eligible for DOD- subsidized child care assistance, including many who pay for child care,  do not use subsidized care because they are not willing to switch to an  eligible provider, or because they have no providers nearby who meet  DOD’s standards. In the long term, DOD is piloting a 13-state initiative  working with other federal agencies and state officials to increase the  quality of child care programs by improving state-level child care  oversight and licensing practices. The pilot’s intended purpose is to  increase the number of providers who meet DOD quality standards. DOD  selected these states, in part, because they have large military  populations.
section_title: Concluding Observations
paragraphs: The flexibility DOD has given the services to set their own child care fee  policies, including subsidy caps for off-installation care, allows the  services to adjust fees and subsidy amounts to meet their budgetary  needs and respond to local cost-of-living variations. However, this  flexibility has also contributed to differences in the out-of-pocket costs  paid by families with similar incomes, both among and within services.  DOD’s efforts to reduce its on-installation fee ranges for families with  similar incomes and its plan to require all services to charge one fee per  income category in a few years may help provide increased financial  consistency for families moving among installations. It is difficult to  determine the degree to which policy changes, such as those related to  subsidy caps, will affect costs for off-installation care for individual  families, because these costs are driven to some extent by private  provider fees, which vary considerably regardless of the services’  policies. However, it is likely that families in the three services with  subsidy caps will, on average, have higher costs than families in the  Army, which does not. Thus, DOD and the services face a policy trade-off  in determining the extent to which they will shoulder child care costs for  military families who cannot obtain on-installation care. For instance,  differences among the services in families’ costs for off-installation care  could be minimized if all services offered subsidies that made up the full  difference between a family’s private provider rate and what they would  have paid for on-installation care, with no subsidy caps. However, such a  policy change would require increased spending on child care for most of  the services, likely requiring them to divert budgetary resources from  other family programs to provide these higher subsidy amounts. In  addition, eliminating the caps could require greater oversight from the  services to ensure that providers did not raise their fee rates in response  to subsidy increases. On the other hand, some services use subsidy caps  to avoid having to limit the number of families who can benefit from  subsidies for off-installation care, so that all eligible families can have at  least some of their child care costs covered. As DOD and the services  move forward with their new fee policies, balancing these competing  priorities will be critical to supporting military families as they serve their  country, while also using resources carefully in an austere fiscal  environment.
DOD has taken some important steps to make military families aware of  DOD-subsidized child care programs, particularly off-installation  subsidies, and to make eligible child care available. Additional steps that  DOD is taking, such as waiving accreditation requirements and piloting a  13-state initiative designed to help states increase the quality of private  providers are important in helping families living off installation obtain  safe, reliable child care. As DOD increases the number of eligible child  care providers for off-installation programs and moves toward centralizing  access to DOD-subsidized child care programs through its planned  agencywide system for requesting both on- and off-installation care,  outreach will need to keep pace, with particular attention to families who  live off installation. DOD anticipates that its proposed marketing plan will  help better ensure that servicemembers are aware of this system once it  is fully implemented. Such a plan also provides an opportunity for  services to identify and share communication strategies with the most  potential. How well DOD executes both its marketing plan and  communication strategies will be crucial to ensuring that all families learn  about DOD-subsidized child care, including families that are  geographically isolated from installations and have few opportunities to  benefit from ongoing contact with installation resources, such as walk-in  information centers, on-installation child care publicity, and contact with  other military families who could tell them about military child care  options. Otherwise, the barriers families face in learning about and  accessing DOD-subsidized child care programs will likely persist.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a copy of this draft report to DOD for comment and review.  DOD provided written comments, which are reproduced in appendix IV of  this report, and technical comments, which we incorporated as  appropriate. In its comments, DOD said that, in general, the report  correctly addresses the issues of providing fee assistance to military  members and assisting with access to child care. DOD also provided  clarification about the following issues: variations in on-installation child  care costs, fee caps, changes in policies to reduce out-of pocket costs,  and family support assistance. DOD also suggested caution in drawing  conclusions based on our random sample.
Regarding variations in per-child, on-installation child care costs, DOD  stated that in practice the fee variations are smaller than those we  reported due to the limited number of programs utilizing the high-cost fee  option. We believe that the report is very specific about not only the actual  fee ranges but also the percentage of installations that are charging these  fees. As stated in the report, we found that 64 percent of military  installations with CDCs charged fees within OSD’s standard fee range in  school year 2010, which means that over a third of the installations  charged fees within OSD’s high-cost range. The high-cost exceptions to  this were a few installations—a total of six and, again, specifically noted in  the report—that had very high cost-of-living allowances and charged fees  that were above OSD’s high-cost range. We recognize that in school year  2011 the number of military installations with CDCs that charged fees  within OSD’s high-cost range declined to about 11 percent and we noted  this in our final report in response to DOD’s comment.
DOD commented that eliminating the caps that three of the services have  placed on off-installation care fee assistance may not require increased  spending on child care for those services. DOD provided an Army  analysis that concludes that the average amount of child care fee  assistance the Army paid per child in recent fiscal years was less than the  capped rate currently paid by the other services. However, the Army’s  analysis does not take into consideration the effect of removing subsidy  caps for those services that have such caps. Based on our analysis, over  60 percent of Air Force and Navy families receiving subsidies for off- installation care were affected by these services’ subsidy caps in school  year 2010. Thus, if the Air Force and Navy were to eliminate their subsidy  caps, they would incur paying higher subsidy amounts to over 60 percent  of families using this type of care, which would increase their total  spending on child care.
DOD stated that in addition to the recent and planned changes to DOD  and the Army’s fee policies that will likely reduce the differences among  the services, the Air Force also implemented fee policy changes reducing  out-of-pocket expenses for families. The Air Force change eliminates  additional fees if a child is in care more than 10 hours per day. However,  our analysis of the child care fees charged by the services did not include  any additional fees they may have charged beyond the base fees for  regularly scheduled care, such as fees for care beyond 10 hours per day.  Thus, eliminating those additional fees would not change the fee  differences among the services that we include in this report.
DOD also commented that in regard to the family support assistance  provided by professional positions, it believes that the Air Force and Navy  provide the same level of service as the Army and Marine Corps, but in a  different manner. We did not assess the level of family support assistance  provided by each service. Instead, we reported the various ways these  services provide such assistance through professionals within and  outside the units and through the services’ support of volunteer  organizations. That said, we recognize the importance of the Navy’s  Family Ombudsman Program and have added it as an example of a  volunteer effort in the report.
In addition to these clarifications, DOD also commented that the GAO  random probability sample of 338 families relative to the total number of  families accessing the system of care indicates the need for caution in  drawing conclusions about accessibility of information and child care  options. We agree that this sample does not represent the total number of  families accessing DOD’s child care system. The sample’s analysis,  which is outlined in appendix I, provides findings related to families’ off- installation child care costs at the family and child level, in conjunction  with other variables such as family income, private provider fees, and the  estimated fee the family would have paid for on-installation care.
We are sending copies of this report to the Secretary of Defense,  appropriate congressional committees, and other interested parties. The  report also is available at no charge on the GAO website at  http://www.gao.gov.
If you or your staff members have any questions about this report, please  contact me at (202) 512-7215 or brownke@gao.gov. Contact points for  our Offices of Congressional Relations and Public Affairs may be found  on the last page of this report. GAO staff members who made key  contributions to this report are listed in appendix V.
section_title: Appendix I: Objectives, Scope, and Methodology
subsections: section_title: Objectives
paragraphs: Our review focused on the following questions: (1) What are the out-of- pocket child care costs paid by military families who use Department of  Defense (DOD) subsidized child care? (2) What are the barriers, if any, to  obtaining DOD-subsidized care, and what has DOD done in response?
section_title: Sample of Family Files
paragraphs: To determine the out-of-pocket costs for families using DOD-subsidized  off-installation care, we analyzed these costs for a random probability  sample of 338 families from all four services in school year 2010.
Specifically, we collected and analyzed data from family files maintained  by the contractor that administers DOD’s off-installation child care  subsidies, the National Association of Child Care Resource and Referral  Agencies (NACCRRA). Our sample included families that participated in  regularly scheduled child care through Operation Military Child Care and  Military Child Care in Your Neighborhood, the two DOD-wide subsidy  programs for off-installation care, as well as smaller service-specific  programs: Army Child Care in Your Neighborhood, Army School-Age  Program in Your Neighborhood, the Army’s Warriors in Transition  program, and the Marine Corps’ San Diego Quality Improvement  Program. This analysis allowed us to generalize our findings to all families  receiving DOD subsidies for off-installation child care in school year 2010.
NACCRRA maintains an electronic database with information that  allowed us to identify all the military families it served in school year 2010.  We used this database to generate our sampling frame of families.  However, since this database does not include the information needed to  calculate families’ out-of-pocket costs, we collected our data variables  from the information contained in paper files NACCRRA maintains for  each family. To create our sampling frame, NACCRRA used the database  to generate a list of all families and children who received DOD subsidies  for off-installation care in school year 2010. In selecting our sample, we  stratified families by service (Air Force, Army, Marine Corps, and Navy)  and either Active Duty or National Guard and Reserves (combined group)  component. No prior data existed on the out-of-pocket child care costs of  military families receiving subsidies that would allow us to calculate the  variance in these costs, which we needed to determine our sample size.  Thus, we collected a presample of 157 files (at least 36 from each  service), calculated the out-of-pocket costs for those families, and then  calculated the variance in costs for each service. We used the variance to  determine the number of family files we would need to collect for the final  sample in order to calculate the margin of error for each stratum to be no  more than plus or minus $90.
To obtain the family files for both the presample and the final sample, we  provided NACCRRA with the family identification numbers for the files we  had randomly selected. When NACCRRA staff had pulled the paper files  for these families, we went to their offices in person to verify the files they  had pulled. NACCRRA staff then scanned the documentation we needed  and sent it to us in PDF form. We requested only documentation  pertaining to school year 2010 (October 1, 2009 through September 30,  2010). We requested and received the following documentation from  each file:
Each child’s schedule of care, all provider rate sheets, all fee calculator(s) used to calculate the subsidy rate, and  servicemember’s deployment orders, if applicable.
Using this documentation, we input data for each family and child in Excel  spreadsheets. We ensured the reliability of these hand-entered data by  having two analysts enter all data, then reconciling any discrepancies  between the two data spreadsheets.
section_title: Data Analysis
paragraphs: For the first objective, to determine the out-of-pocket costs for families  using on-installation care, we obtained data from DOD and the services  on the range of fees charged per child at installations in school years  2010 and 2011. Family-level cost data for on-installation care were not  available. Our analysis on families’ out-of-pocket costs is limited to their  weekly or monthly child care fees, although families may pay additional  costs, such as fees for special events and activities. In addition, our  analysis of these fee data focused on school year 2010, so that we could  present data on costs for on-installation care that covered the same time  period as our data on off-installation care costs. We also analyzed  changes to the on-installation fee ranges in school year 2011. DOD and  three of the four services provided data on weekly fees, while the fourth  service (Army) provided monthly fees. We converted DOD and the other  services’ weekly fees to monthly fees using the same calculation used by  the Army to obtain monthly fees. Specifically, we multiplied the weekly  fees by 365/7 (the number of weeks in a year) to get the yearly fee  amount, and then divided by 12 to obtain the monthly fee amount. This  calculation assumes a 365-day year, as well as an equal number of days  in each month. Since months vary slightly in length, the monthly amount  paid by families in services that charge fees on a weekly basis will also  vary slightly. In addition, all Army installations allow families 2 weeks of  vacation per year, during which they do not pay child care fees if their  children are not in care. Army families’ monthly fees are calculated such  that families pay more during the other 50 weeks of the year to make up  for the 2 weeks of vacation. We recalculated Army fees without this  vacation credit to make them comparable to other services’ fees, which  are generally not reported in this form.
To determine families’ costs for off-installation care, we collected data  from a sample of 338 NACCRRA family files, as described above. We  analyzed these data to determine families’ off-installation child care costs  at the family and child level, in conjunction with other variables such as  family income, private provider fees, and the estimated fee the family  would have paid for on-installation care. We compared the averages of  these variables across services. In this analysis, we weighted family and  child data based on the family’s probability of being selected for the  sample, which varied due to differences in the population size of each  stratum (e.g., families of active duty Army servicemembers). Because we  followed a probability procedure based on random selections, our sample  was only one of a large number of samples that we might have drawn.  Since each sample could have provided different estimates, we express  our confidence in the precision of our particular sample’s results as a 95  percent confidence interval (e.g., plus or minus $100). This is the interval  that would contain the actual population value for 95 percent of the  samples we could have drawn.
For this objective, we also reviewed the child care fee policies set by  DOD and the services for school years 2010 and 2011, including the fees  charged to families for on-installation care, any discounts offered to  families, and how subsidies are calculated for off-installation care. Some  aspects of the services’ fee policies, such as their methods of calculating  subsidies for off-installation care, were not contained in written policies.  We obtained this information through interviews with DOD and service  officials. We also interviewed these officials regarding the implementation  of these policies.
section_title: Data Reliability
paragraphs: Because external data were significant to our research objectives, we  assessed the reliability of the data obtained from DOD and NACCRRA. To  assess the reliability of the data on the range of fees charged by each  service in school years 2010 and 2011, we interviewed officials from each  service on their annual process for collecting and reviewing data on the  fees charged by their installations. To assess the reliability of the  NACCRRA data that we used as the sampling frame for our sample of  families using off-installation care, we interviewed NACCRRA officials  about their database and how they maintain it. To assess the reliability of  the Defense Manpower Data Center data that we used to determine the  number of servicemembers and their children who were eligible for DOD  child care assistance in fiscal year 2011, we interviewed Defense  Manpower Data Center officials about the reliability of the relevant data  fields and also conducted electronic testing of the data. We found the data  we assessed to be sufficiently reliable for the purposes of reporting the  range of on-installation fees per child by service in school years 2010 and  2011, and out-of-pocket costs for families using DOD-subsidized off- installation child care in school year 2010. We found that the Defense  Manpower Data Center data may not capture 100 percent of the children of  servicemembers who are eligible for child care, because Guard and  Reserve members are not required to report their children in the data  system that populates the Defense Manpower Data Center data fields on  servicemembers’ children. In addition, we found that, because the Defense  Manpower Data Center data we received included members of all reserve  categories, these data included some servicemembers and children who  were not eligible for child care. We determined that these limitations were  minor enough to allow us to report the approximate number of  servicemembers eligible for DOD child care in the background of the report.
section_title: Installation Site Visits and Structured Discussion Groups
paragraphs: To address the second objective, we reviewed relevant federal laws,  policies and guidance, studies and surveys of military parents, and  interviewed child and youth program officials with DOD and each of the  four services, including officials at service headquarters and installations.  We also interviewed representatives of NACCRRA, nonprofit  organizations that support military families, and researchers  knowledgeable about DOD child care programs. In addition, we visited  two large military installations (Joint Base Lewis-McChord, Wash.— Army/Air Force), and Marine Corps Base Camp Lejeune, N.C.) and  conducted phone interviews with officials at two additional large military  installations (Naval Station Norfolk, Va., and Nellis Air Force Base, Nev.)  to learn how each implements child care programs and discuss barriers  faced by families in obtaining access to these programs. To obtain  examples of child care programs and barriers faced by military parents at  installations with no on-installation child care facilities, we also conducted  telephone interviews with officials at two small installations affiliated with  two services (Army’s Yakima Training Center, Wash., and Creech Air  Force Base, Nev.), for a total of four phone interviews with installations.  For our site visits, we selected large installations that had a Guard and/or  Reserve presence and had significant deployment activity. Visiting two  large installations—one each representing the Army and Marines–– provided examples of a large and a small service’s approaches to child  care programs. We also selected one installation that is a joint base— having two military services on base—the Army, the lead service, and the  Air Force.
During our site visits we also conducted six semi-structured discussion  groups with military parents at Joint Base Lewis-McChord, and five at  Marine Corps Base Camp Lejeune, including parents who did and who  did not have their children enrolled in DOD-subsidized child care. We also  held two additional semi-structured discussions with reserve  servicemembers at Camp Lejeune. During these semi-structured  discussions we inquired into how parents learned about DOD-subsidized  child care and any barriers they may have encountered obtaining this  care. In addition, we conducted phone interviews with child care officials  and military parents at two additional large military installations—Naval  Station Norfolk, Va., and Nellis Air Force Base, Nev. The information  obtained during these visits and through phone calls is illustrative and not  representative of each service or of DOD programs as a whole.
In order to select servicemembers for our small discussion groups at the  two sites we visited, we provided DOD with selection criteria that they  used to identify servicemembers to invite to these groups. Because we  held separate discussions with officers and enlisted servicemembers, we  used the same criteria for each. Our criteria were officers and enlisted  servicemembers with children 12 and under who were using DOD child  care—including both on-installation facilities and off-installation  community care subsidies—and those not using such care. In addition, at  each site we visited we also met with a small group of spouses of  servicemembers with children 12 and under. Many of these spouses  worked for a DOD family support office or were members of military  organizations that serve spouses, such as the Marine Corps L.I.N.K.S  program, which is a volunteer, mentoring program, designed by Marine  Corps spouses to help family members understand and adapt to the  unique challenges of military life.
section_title: Review of NACCRRA Studies
paragraphs: To assess the methodological quality of a NACCRRA study we used to  support the scarcity of providers eligible to receive DOD child care  subsidies, we reviewed the study’s methodology and also obtained  responses from NACCRRA to questions we had about this methodology.  We used a different NACCRRA study to identify differences in how states  oversee and regulate private child care providers.not include a methodology, we obtained information from NACCRRA  about the methodology it used to prepare this report. We also confirmed  certain information NACCRRA included in the study for the two states  where we performed site visits at installations in order to help verify the  accuracy of this information and found no relevant discrepancies between  the study and state-provided information. We found these reports to be  sufficiently reliable for the purposes described above.
section_title: Appendix II: On-Installation Fee Ranges in School Year 2011
section_title: Appendix III: Supplemental Data from Sample of Families Using DOD-Subsidized Off-Installation Care
paragraphs: Appendix III: Supplemental Data from Sample  of Families Using DOD-Subsidized Off- Installation Care 95% margins of sampling error for these estimates range from +/- $5,197 to +/- $14,928.  95% confidence intervals for these estimates do not exceed $33,155 to $59,947.  95% confidence intervals for these estimates do not exceed $93,432 to $183,538.  95% margins of sampling error for these estimates range from +/- 5.7% to +/- 10.5%.
section_title: Appendix IV: Comments from the Department of Defense
section_title: Appendix V: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contact
section_title: Acknowledgments
paragraphs: Janet Mascia, Assistant Director, and Julianne Hartman Cutts, Analyst-in- Charge, managed this assignment. Caitlin Croake, Lauren Gilbertson,  Hayley Landes, and Suzanne Rubins made significant contributions to all  aspects of this report. Kate Van Gelder, Holly Dye, and James Bennett  provided writing and graphics assistance. In addition, Kirsten Lauber,  Terry Richardson, Jeff M. Tessin, and Cynthia Grant provided design and  methodological assistance. James Rebbe provided legal assistance.