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

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on February 27, 2012

Program Summary

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.

Program Description

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, 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 suspected perpetrator of a 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 perpetrator 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 perpetrators.

Evaluation Outcomes

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Study 1

Crandall and Helitzer (2003) found that the Sexual Assault Nurse Examiner (SANE) treatment group had significantly more referrals than the control group. The average number of referrals for the pre–SANE group was 1.7, compared with 4.0 in the SANE group.

Time in Treatment
The amount of time that victims in the treatment group spent at SANE was significantly less than the time that the victims in the control group spent in the emergency department. The mean amount of time spent in receiving treatment was 49 minutes shorter for the SANE intervention group than for the pre–SANE group treated in the emergency department.

Medical Treatment
SANE patients more often accepted pregnancy tests (88 percent of the SANE group did, versus 79 percent of the pre–SANE group), pregnancy prophylaxis (87 percent, versus 66 percent), and treatment for sexually transmitted infections (97 percent, versus 89 percent). All group differences were statistically significant.

Evidence Collection
The treatment group had significantly higher levels of forensic examinations, with consent to forensic sample collection being given in 98 percent of cases, compared with 47 percent of pre–SANE cases. Evidence collection and microscopic evidence collection was also significantly higher for SANE patients than in the control group. Vaginal photography was also significantly higher (88 percent) in the treatment group that in the control group (8 percent).

Reports to Police
The rate of reporting to police was 46 percent in the pre–SANE group, and was significantly higher in the treatment group—with 67 percent of victims filing a police report.

The number of charges per cases, the proportion of cases presented to the grand jury, and the proportion of charges resulting in an indictment all increased significantly from pre–SANE to SANE cases. In addition, the conviction rate increased significantly, from 59 percent before SANE to 69 percent after SANE. There were no differences in the number of dismissals or acquittals. However, a significantly greater percentage of SANE cases resulted in jail time (46 percent before, versus 55 percent after). Also, sexual assault cases before SANE were sentenced to 1.2 years, versus 5.1 years of incarceration after SANE—a statistically significant difference.
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Evaluation Methodology

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Study 1
The 2003 Crandall and Helitzer study is an evaluation of a Sexual Assault Nurse Examiner (SANE) program in Albuquerque, N.M. The study uses 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 offender, 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.

Notably, the implementation of the SANE program was accompanied by a widespread awareness of sexual assault in the community, especially among service providers and law enforcement. While this awareness is essentially a prerequisite to implementing the SANE Units (i.e., the referral systems), it does make the isolation of the effects of the SANE component more problematic.
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There is no cost information available for this program.
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Evidence-Base (Studies Reviewed)

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

Study 1
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.
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Related Practices

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Following are practices that are related to this program:

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 No Effects for the proportion of complainants who had a rape kit collected.

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
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Program Snapshot

Gender: Female

Race/Ethnicity: Black, American Indians/Alaska Native, Asian/Pacific Islander, Hispanic, White

Geography: Rural, Suburban, Urban

Setting (Delivery): Inpatient/Outpatient

Program Type: Crisis Intervention/Response, Gender-Specific Programming, Victim Programs, Court Processing

Targeted Population: Females, Victims of Crime

Current Program Status: Active

Cameron Crandall
Associate Professor/Vice Chair for Research
Center for Injury Prevention Research & Education, University of New Mexico
Department of Emergency Medicine, MSC10 5560, 1 University of New Mexico
Albuquerque NM 87131
Phone: 505.272.5062
Fax: 505.272.6503