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Practice Profile

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

Evidence Ratings for Outcomes:

Effective - One Meta-Analysis Victimization - Treatment for Sexually Transmitted Infections
Effective - One Meta-Analysis Victimization - Administration of Emergency Contraception
No Effects - One Meta-Analysis Victimization - Rape Kits Collected

Practice Description

Practice Goals
Sexual Assault Nurse Examiners (SANEs) are qualified nurses who are trained to gather forensic evidence in cases of rape and sexual assault (of both adults and children). SANEs may also be referred to as Forensic Nurse Examiners (FNEs) in countries such as the United Kingdom.
 
In SANE interventions, nurses conduct forensic evidence examinations (i.e., rape kits) of victims of rape or sexual assault, in lieu of forensic doctors. The goal is to provide safe and privacy-conscious treatment that coordinates health care with counseling services, forensic collection, law enforcement, and prosecution.
 
Services Provided
SANEs are responsible for conducting the forensic examinations; collecting and documenting the findings; and working with police and prosecutors to offer ongoing case consultation, including testifying as expert witnesses if the case goes to trial.

SANEs provide comprehensive psychological, medical, and forensic services to the victims. SANE interventions provide a number of different services, including crisis intervention and emotional support; injury detection and treatment; and health care (e.g., screening for sexually transmitted infections [STIs], prophylaxis or antibiotics for STIs, pregnancy testing, and emergency contraception). SANEs are also meant to spend more time with patients, show greater empathy, and help patients to foster a sense of control and empowerment. 

Meta-Analysis Outcomes

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Effective - One Meta-Analysis Victimization - Treatment for Sexually Transmitted Infections
From the two studies, Toon and Gurusamy (2014) found a small, yet statistically significant difference between victims treated by SANEs, compared with those treated by non-SANE health professionals in regard to the treatment of STIs (i.e., provision of STI prophylaxis/antibiotics). Sexual assault/rape victims cared for by SANEs were significantly more likely to be offered treatment for an STI, compared with those cared for by non-SANE health professionals.
Effective - One Meta-Analysis Victimization - Administration of Emergency Contraception
From the two studies, Toon and Gurusamy (2014) also found a small, yet statistically significant difference between victims treated by a SANE, compared with those treated by a non-SANE health professional with regard to administration of emergency contraception (i.e., pregnancy prophylaxis). Sexual assault/rape victims cared for by SANEs were significantly more likely to be offered emergency contraception, compared with those cared for by non-SANE health professionals.
No Effects - One Meta-Analysis Victimization - Rape Kits Collected
Looking at outcomes from two studies, Toon and Gurusamy (2014) found there were no significant between-group differences with regard to the proportion of rape kits collected from victims (i.e., complainants) seen by Sexual Assault Nurse Examiners (SANEs) and those seen by non-SANE health professionals.
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Meta-Analysis Methodology

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Meta-Analysis Snapshot
 Literature Coverage DatesNumber of StudiesNumber of Study Participants
Meta-Analysis 11997 - 201262700

Meta-Analysis 1
Toon and Gurusamy (2014) conducted a meta-analysis to compare the outcomes of sexual assault and rape cases handled by Sexual Assault Nurse Examiners (SANEs) with the outcomes for cases handled by non-SANE health professionals. The focus of the meta-analysis was on the efficacy of SANEs (compared with non-SANE health professionals) to conduct forensic medical examinations and collect forensic evidence from victims (i.e., complainants) of rape and sexual assault. A comprehensive search was conducted to identify experimental and quasi-experimental studies comparing outcomes for victims of rape and/or sexual assault who were treated by a SANE, with those treated by a non-SANE health professional. Non-SANE health professionals included both specially trained and general physicians.  

A total of six studies were identified and included in the meta-analysis. The six studies provided an overall sample size of 2,700 victims (1,223 were examined by a SANE and 1,477 were examined by a non-SANE health professional). One study (Betchel, Ryan, and Gallagher 2008) examined the effect of SANEs on pediatric victims of sexual assault (98 percent were female, with the mean age of 14 years). One study (Regan, Lovett, and Kelly 2004) evaluated the service offered to adults in the United Kingdom (92 percent were female). The other four studies evaluated services offered to adults in the United States (Campbell et al. 2012; Crandall 2003; Derhammer et al. 2000; Ledray and Simmelink 1997). No other information was provided on the sample of victims included in the studies. 
 
The outcomes of interest included provision of sexually transmitted infection (STI) and pregnancy prophylaxis, and proportion of complainants who had a rape kit collected. Risk ratios or mean differences were calculated using both random-effects and fixed-effects models.
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Cost

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There is no cost information available for this practice.
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Implementation Information

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In the United States, Sexual Assault Nurse Examiners (SANEs) are required to take over 40 hours of classroom-based training, followed by 40 to 90 hours of clinical training prior to qualifying as a SANE (Toon and Gurusamy 2014). There are currently two national protocols for medical forensic examinations available from the U.S. Department of Justice, Office on Violence Against Women: 1. A National Protocol for Sexual Assault Medical Forensic Examinations–Adults/Adolescents (2nd Edition), 2013: https://www.ncjrs.gov/pdffiles1/ovw/241903.pdf 2. A National Protocol for Sexual Abuse Medical Forensic Examinations–Pediatric, 2016: https://www.justice.gov/ovw/file/846856/download
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Evidence-Base (Meta-Analyses Reviewed)

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

Meta-Analysis 1
Toon, Clare, and Kurinchi Gurusamy. 2014. “Forensic Nurse Examiners versus Doctors for the Forensic Examination of Rape and Sexual Assault Complainants: A Systematic Review.” Campbell Systematic Reviews 5.

http://www.campbellcollaboration.org/lib/project/272/
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Additional References

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

Bechtel, Kirsten, Elizabeth Ryan, and Deborah Gallagher. 2008. “Impact of Sexual Assault Nurse Examiners on the Evaluation of Sexual Assault in Pediatric Emergency Department.” Pediatric Emergency Care 24:442–47.


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.


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, National Institute of Justice.


Derhammer, Frances, Vincent Lucente, James F. Reed, and Mark J. Young. 2000. “Using a SANE Interdisciplinary Approach to Care of Sexual Assault Victims.” The Joint Commission Journal on Quality Improvement 26(8):488–96.


Ledray, Linda E., and Kathy Simmelink. 1997. “Efficacy of SANE Evidence Collection: A Minnesota Study.” Journal of Emergency Nursing 23(1):75–77.


Regan, Linda, Jo Lovett, and Liz Kelly. 2004. Forensic Nursing: An Option for Improving Responses to Reported Rape and Sexual Assault. London, England: Great Britain Home Office, Communication Development Unit, Research Development and Statistics Directorate.


Sievers, Valerie, Sherri Murphy, and Joseph J. Miller. 2003. “Sexual Assault Evidence Collection More Accurate When Completed by Sexual Assault Nurse Examiners: Colorado’s Experience.” Journal of Emergency Nursing 29(6):511–14
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Related Programs

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

Sexual Assault Nurse Examiner (SANE) Program - Multisite Promising - One study
The program uses specially trained nurses to provide comprehensive psychological, medical, and forensic services for 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 were more likely to result in a guilty plea or conviction.

Sexual Assault Nurse Examiner (SANE) Program (Albuquerque, N.M.) Promising - One study
The program aims to provide specialized and coordinated services to victims of sexual assault during their first contact with the health care environment. The program is rated Promising. The treatment group had more referrals, spent less time receiving treatment than the control group spent in the emergency department; received more medical treatment; had higher levels of evidence collection; and had more reports to the police and prosecutions.
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Practice Snapshot

Age: 14+

Gender: Both

Targeted Population: Victims of Crime

Settings: Inpatient/Outpatient

Practice Type: Crisis Intervention/Response, Victim Programs

Unit of Analysis: Persons