Program Profile: Sexual Assault Nurse Examiner (SANE) Program (Albuquerque, N.M.)

This program provides specialized and coordinated services to victims of sexual assault during their first contact with the health care system. The program is rated Promising. Treatment group patients had a statistically significant greater number of referrals to victim services and greater likelihood of consenting to evidence collection, pregnancy tests, and STD treatment, compared with control group patients treated in the standard emergency room.

A Promising rating implies that implementing the program may result in the intended outcome(s).

A Promising rating implies that implementing the program may result in the intended outcome(s).

Program Goals

The Sexual Assault Nurse Examiner (SANE) program aims to provide specialized and coordinated services to victims of sexual assault during their first contact with the health care environment. The goal of the program is to provide safe and privacy-conscious treatment to very recent victims of sexual assault in a response that coordinates health care with counseling services, forensic collection, law enforcement, and prosecution.

Target Population

The SANE program extends services to recent victims of sexual assault when activated by a referral from participating medical services, law enforcement, or other services. SANE Units are stationed at hospitals, and likely to be primary contact points with victims of sexual assault. However, participating emergency rooms (ERs), police departments, and rape crisis centers contact the program to dispatch a SANE nurse and a rape crisis advocate, should there be none onsite.

Services Provided

The program guides patients through services including medical treatment, treatment for sexually transmitted infections (STIs), emergency contraception, contact with law enforcement, collection of forensic samples, and referrals to other services in a secure and private manner. This is done to provide services to the victim in a more environmentally appropriate manner, to address health care and law enforcement concerns, and to try to provide a swifter and less traumatic service delivery.

From referral, victims are assessed for their need for medical treatment. Depending on the victims’ medical needs, either a SANE nurse and rape crisis advocate can be dispatched onsite or the victim can be discharged to a SANE Unit, where a forensic exam can be conducted if desired. Additionally, the SANE nurse offers STI testing and treatment as well as emergency contraception. Finally, a police interview can be arranged if the victim desires before she (or he) is discharged, often with referrals to multiple services. If criminal proceedings are brought against a person suspected of sexual assault, the SANE nurse who examined the victim can testify in court.

Key Personnel

The Sexual Assault Nurse Examiner program, as the name suggests, relies heavily on SANE nurses, but it also requires the sustained involvement and availability of rape crisis advocates. The program requires the cooperation and widespread knowledge of its services among hospital ERs, law enforcement agencies, and prosecutorial services.

Program Theory

The SANE program aims to provide better health outcomes and to increase the proper forensic collection of data, and also to ultimately increase prosecutions in cases of sexual assault. The program achieves this by offering a range of coordinated services adapted to sexual assault victims’ needs at the point of contact with health or law enforcement services, instead of regular ER services—which deprive the victim of the privacy she (or he) may require in such a traumatic situation. By offering these services in a victim-sensitive manner, the SANE program aims to increase the likelihood of their uptake, which should increase positive health outcomes for victims and increase law enforcement’s odds of intercepting and prosecuting persons suspected of the crime.

Study

Crandall and Helitzer (2003) evaluated the Sexual Assault Nurse Examiner (SANE) program in Albuquerque, N.M. They used a quasi-experimental design comparing the experience of sexual assault victims before and after the implementation of a SANE program. The control pre–SANE sample consisted of 242 victims. The SANE treatment group consisted of 715 victims, who were gathered from medical and SANE unit records. Victims were included when sexual assault was indicated in their record. Other data sources, such as law enforcement and court data, were used to collect information on other outcomes. However, owing to difficulties in matching the cases across sources, each dataset was analyzed separately. Sample sizes for criminal justice outcomes varied: there were 384 control and 1,046 treatment police suspects; 291 control and 412 treatment prosecution suspects; and 194 control and 273 treatment court cases. A qualitative component to the study included interviews with key informants, but because of access issues there was little contact with victims or public defenders.

The pre–SANE control group victims were treated in emergency rooms (ERs) of medical facilities and entered the triage system. If a history of sexual abuse was noted, the ER would contact a rape crisis adviser. However, the victim would navigate the normal ER treatment process, often in hospital waiting rooms which lack the privacy and sensitivity of service delivery that may be more appropriate to her (or his) situation. The treatment group was referred to SANE Units by ERs, law enforcement, and rape crisis centers. If a victim required medical treatment and hospitalization, SANE nurses and rape crisis advocates would be dispatched to the hospital.

Victim participants were exclusively female and had to be over 18 years old, for human data collection reasons. While the groups didn’t differ on age, they did differ in the number of unspecified or missing relationship statuses to the person who perpetrated the crime, with the SANE program participants rarely registering in this category. Additionally, a significantly greater number of post–SANE victims than pre–SANE victims were accompanied by their spouses. The groups were not, however, significantly different on any other demographic or ethnic variables.

Outcomes of interest included the number of referrals to victim services, consent to forensic evidence collection, consent to medical treatment such as pregnancy testing and sexually transmitted disease (STD) treatment, time in treatment, police reports filed following treatment, and convictions of offenders. The study authors conducted t tests to compare treatment and control groups. No subgroup analyses were conducted.

These sources were used in the development of the program profile:

Following are CrimeSolutions-rated programs that are related to this practice:

Sexual Assault Nurse Examiners for Forensic Examinations in Cases of Sexual Assault/Rape

This practice uses qualified nurses who are trained to collect forensic evidence in cases of rape and sexual assault (of both adults and children). The practice is rated Effective for providing treatment for sexually transmitted infections and emergency contraception to sexual assault/rape victims but is rated Ineffective for the proportion of complainants who had a rape kit collected.

Evidence Ratings for Outcomes

	Victimization - Treatment for Sexually Transmitted Infections
	Victimization - Administration of Emergency Contraception
	Victimization - Rape Kits Collected

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?