Roles and Limitations

With the emergence of SANE programs in their communities, agencies involved in the community response system to sexual assault must work together to reexamine response protocols and revise them as necessary to ensure effective service delivery. In the course of successfully integrating SANE programs into response systems, some conflicts will arise. These issues must be resolved as early as possible to avoid power struggles. In particular, SANE coordinators and advocacy center directors may need to collaborate to identify past problems in coordinated medical-legal service delivery and areas where blurring of roles could occur. A few issues that should be considered are—

• Shift in the advocate's focus of attention. The need for advocates to monitor the medical-forensic response is greatly diminished when SANEs are conducting evidentiary exams, because of their education, training, and experience. Trusting that SANEs will provide sensitive and competent care and forensic nursing evaluation, advocates can more fully concentrate on providing crisis counseling, emotional support, and information to victims and their families.

• By profession, SANEs are not victim advocates. SANEs support victims by providing caring, respectful, and efficient emergency medical-legal treatment. Victim support provided by SANEs, however, is not a substitute for services offered by advocates. Staff from sexual assault advocacy programs have specialized training, experience, and access to program resources that allow them to address a wide range of victim needs during the emergency medical-legal process and beyond.²⁷

• Victim use of advocacy services. Although victims should decide for themselves whether they would like an advocate present during the exam, SANEs can inform victims of opportunities to use advocacy services and can explain the benefits of advocate assistance.

• Clarification of responsibilities. SANE programs and sexual assault crisis centers in the same locality may offer a few similar victim services during emergency medical-legal procedures, including crisis intervention or provision of information about reporting options. Agency directors should work together to clearly delineate separate functions, eliminate duplication, and/or determine the appropriateness of collaboratively delivering some services.

• Support for SANE work. When advocates provide emotional support for victims during exams, SANEs can more easily maintain a neutral and objective stance. Victims are usually able to talk with advocates in confidence,²⁸ whereas statements they make to SANEs may become part of the medical-forensic report that is passed on to detectives (if the case is reported).

• Competency of volunteer advocates. In addition to paid staff, many sexual assault crisis centers use trained volunteers to provide advocacy services. Volunteers typically receive ongoing supervision from center staff. Any concerns that SANEs have about the quality of services provided by volunteers should be discussed with the local center director or designated contact person.

SANEs and advocates tend to agree that there is more than enough work for everyone involved in sexual assault victim response. By resolving differences, recognizing the benefits of working collaboratively, and clarifying roles, SANEs and advocates can support one another in their effort to serve victims. Agency-specific and joint trainings are invaluable tools in making sure advocates and SANEs understand each other's roles and limitations and avert problems in service delivery. Sara Donohue, Coordinator of the Sexual Assault Resource and Awareness Program in Alexandria, Virginia, also recommends that cooperative agreements be created to standardize response and build commitment of responding agencies to work together.³⁰

After attending a SANE training, Gail Hutchison, the Sexual Assault Services Coordinator for Virginians Aligned Against Sexual Assault in Charlottesville, Virginia, felt better prepared to support the development of SANE programs in localities across the state and to encourage collaboration among advocates, nurses, law enforcement officers, and prosecutors.³¹

Judy Casteele, Associate Director of the Women's Resource Center of the New River Valley in Radford, Virginia, attended a SANE training about 4 years ago. Impressed by what she learned, she asked the trainers to present information on SANE programs to law enforcement officers, prosecutors, nurses, emergency room doctors, and other physicians in Radford. An enthusiastic response to the presentation led Casteele to urge area hospitals to consider implementing a SANE program. One hospital agreed and subsequently involved Casteele in the selection of the SANEs. Casteele maintains regular communication with the SANEs and supports them in their work.³²