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The program uses specially trained nurses to provide comprehensive psychological, medical, and forensic services to recent sexual assault victims in either hospital- or community-based clinic settings. The program is rated Promising. Across multiple sites, the results showed that sexual assault cases that were prosecuted following implementation of SANE had a statistically significant greater likelihood of resulting in a guilty plea or conviction.
A Promising rating implies that implementing the program may result in the intended outcome(s).
This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.
A Promising rating implies that implementing the program may result in the intended outcome(s).
This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.
Program Goals
The Sexual Assault Nurse Examiner (SANE) program is a multidisciplinary response intervention that aims to improve postassault care for victims, through specialized coordinated services, while also increasing reporting and prosecution rates (Campbell, Patterson, and Bybee 2012). As opposed to emergency department physicians caring for sexual assault victims, specially trained SANE nurses provide comprehensive psychological, medical, and forensic services to the victims. The goal of the program is to provide safe and privacy-conscious treatment to recent sexual assault victims in a response that coordinates health care with counseling services, forensic collection, law enforcement, and prosecution. Further, through working with police and prosecutors, the SANE program seeks to increase the sexual assault prosecution rates. Overall, the SANE program strives to minimize the victim’s physical and psychological trauma, while maximizing the probability of evidence collection and preserving physical evidence for use in the legal system, if necessary (Young et al. 1992).
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, which are likely to be primary contact points for 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 none be onsite.
Program Activities
The SANE program was designed to avoid problems with traditional hospital care of sexual assault victims by having specially trained nurses, rather than emergency department physicians, provide the first-response care to sexual assault victims. The program guides patients through services including crisis intervention and emotional support; health care (e.g., screening for sexually transmitted infections (STIs), antibiotics for STIs, pregnancy testing, and emergency contraception); injury detection and treatment; and forensic medical evidence collection. Moreover, SANE program staff work with police and prosecutors to offer ongoing case consultation and, if the case goes to trial, may testify as expert witnesses. To address victims’ psychological needs, SANE focuses on treating the victim with dignity and respect to ensure the victim is not traumatized by the exam, and works with local rape crisis centers to provide additional emotional support to victims (Campbell, Patterson, and Bybee 2012).
In addition to the extensive post-assault services for rape victims, SANE provides law enforcement personnel and prosecutors with valuable resources, including state-of-the-art medical forensic evidence, in an effort to increase the rate prosecution rate. This evidence includes a comprehensive head-to-toe examination of the survivor’s body to check, document, and treat any injuries that resulted from the assault (Campbell, Patterson, and Fehler-Cabral 2010). Further, the SANE program uses forensic equipment that is often not offered in traditional hospital emergency departments, such as a colposcope, which detects anogenital microlacerations, bruises, and other injuries. These results are then immediately sent to the police and prosecutors; and, if the case is tried, the results are presented in court (Campbell, Patterson, and Fehler-Cabral 2010). Overall, the SANE program uses comprehensive care that involves the efforts of multiple service providers to assist the victims in their recovery and increase prosecution rates. (Campbell, Patterson, and Bybee 2012).
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.
Study 1
Sexual Assault Prosecution Rates
Campbell and colleagues (2014) found no significant differences in the prosecution rates of sexual assault cases when looking at the six Sexual Assault Nurse Examiner (SANE) sites individually. However, when the data was aggregated across all of the sites, they found that cases processed post-SANE were significantly more likely than pre-SANE cases to result in a guilty plea or conviction (about 1.8 times more likely). It should be noted, though, that the overall number of sexual assault cases that were even considered for prosecution was still very low (only 14 percent).
Study
Campbell and colleagues (2014) conducted a replication study of their earlier study (2012) that included a multisite evaluation of six Sexual Assault Nurse Examiner (SANE) programs. The goal of the study was to assess whether the SANE program increased prosecution rates of sexual assault cases. To avoid potential disruption of services, researchers focused on sites that were already organizationally ready for a program evaluation. Due to this stipulation, sites were deemed eligible for the study if they had 1) a full-time SANE program coordinator, 2) nursing staffing levels equivalent to the current patient caseload, 3) a mean “organizational readiness score” above the 25th percentile, and 4) access to legal case outcome data. After identifying 10 eligible sites, random sampling was used to select six SANE programs for evaluation, stratified by geography (two rural, two midsized, and two urban communities). Three of these sites conducted pre–post evaluations, while three sites conducted post-only evaluations due to data restrictions. The different data collection designs were evenly distributed across strata.
After selecting the evaluation sites, program staff collected official criminal justice outcome data on 1,696 sexual assault cases, both pre- and post-SANE. Cases for examination were selected based on the following criteria: 1) the patient was at least 18 years old at the time of the assault, 2) the patient had a complete medical forensic exam and evidence collection, 3) the exam and evidence collection were not anonymous/de-identified, 4) the police report was not anonymous or “Jane Doe,” and 5) the assault occurred within the county being examined.
Case outcomes were categorized in the following three ways: 1) the case was not referred by police/not charged by prosecutors, 2) the case was charged by prosecutors and later dropped or acquitted, and 3) there was a guilty plea or conviction. Unknown/pending cases were identified and not included in the analyses. The cases spanned a 14-year period, from June 1995 through September 2009. Multilevel modeling was used to examine the impact of the SANE programs on case outcomes. Researchers first analyzed data individually by site, finding that the different data collection methods did not significantly affect case outcomes. The data collection variable was subsequently dropped from the analysis. To increase statistical power, researchers aggregated the data across sites and repeated the analyses. The study authors conducted subgroup analyses to examine the difference in guilty pleas and convictions at each individual site from pretest to posttest.
Sexual assault forensic nurses are specially trained in crisis intervention, injury detection and treatment, health care pertaining to sexual assaults (i.e., sexually transmitted infection screening, pregnancy testing, and emergency contraception), and forensic medical evidence collection. Nurses also provide consultation for police and prosecutors and sometimes testify as expert witnesses should a case go to trial.
Other Sexual Assault Nurse Examiner (SANE) program staff was trained via webinars, group consultation calls, phone and email consultation, and in-person site visits. Training covered an overview of the project and research process and a detailed explanation of the research design.
Further, through the SANE Practitioner Evaluation Toolkit, program staff is taught how to evaluate whether prosecution rates increased in their communities after the implementation of SANE programs. Through understanding evaluation data, program staff can determine if the program is achieving the desired positive effects and if not, use the data to guide reform efforts (Campbell et al. 2013).
Subgroup Analysis
Campbell and colleagues (2014) conducted subgroup analyses to examine the difference in guilty pleas and convictions at each individual site (i.e., two rural, two midsized, and two urban communities) from pretest to posttest. They found no statistically significant differences in guilty pleas and convictions at the individual site level.
These sources were used in the development of the program profile:
Study
Campbell, Rebecca, Deborah Bybee, Stephanie M. Townsend, Jessica Shaw, Nidal Karim, and Jenifer Markowitz. 2014. “The Impact of Sexual Assault Nurse Examiner Programs on Criminal Justice Case Outcomes: A Multisite Replication Study.” Violence Against Women 20(5):607–25.
These sources were used in the development of the program profile:
Campbell, Rebecca, Debra Patterson, and Deborah Bybee. 2012. “Prosecution of Adult Sexual Assault Cases: A Longitudinal Analysis Impact of a Sexual Assault Nurse Examiner Program.” Violence Against Women 18(2):223–44.
Campbell, Rebecca, Debra Patterson, and Giannina Fehler-Cabral. 2010. “Using Ecological Theory to Evaluate the Effectiveness of an Indigenous Community Intervention: A Study of Sexual Assault Nurse Examiner (SANE) Programs.” American Journal of Psychology 46:263–76.
Campbell, Rebecca, Stephanie Townsend, Deborah Bybee, Jessica L. Shaw, and Jenifer Markowitz. 2013. Implementation of a Sexual Assault Nurse Examiner (SANE) Practitioner Evaluation Toolkit. Washington, D.C.: U.S. Department of Justice.
Crandall, Cameron S., and Deborah Helitzer. 2003. Impact Evaluation of a Sexual Assault Nurse Examiner (SANE) Program. Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, National Institute of Justice.
Young, W., A. C. Bracken, M. A. A. Goddard, and S. Matheson. 1992. “The New Hampshire Sexual Assault Medical Examination Protocol Project Committee Sexual Assault: Review of a National Model Protocol for Forensic and Medical Evaluation.” Obstetrics & Gynecology 80:878–83.
Following are CrimeSolutions-rated programs that are related to this practice:
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
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Victimization - Treatment for Sexually Transmitted Infections |
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Victimization - Administration of Emergency Contraception |
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Victimization - Rape Kits Collected |
Age: 18+
Gender: Female
Geography: Suburban Urban Rural
Setting (Delivery): Other Community Setting
Program Type: Crisis Intervention/Response, Victim Programs
Targeted Population: Victims of Crime
Current Program Status: Active