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Implementing SANE Programs in Rural Communities: The West Virginia Regional Mobile SANE Projectsubnavigation
Publication Date:  June 2008
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Office of Justice Programs Seal   Office for Victims of Crime, Putting Victims First

Replication Checklist

The West Virginia Regional Mobile SANE Project has great potential for replication in rural regions. The checklist included here will guide communities seeking to replicate the project in their own states and counties.* Those involved in planning need to consider how the tasks in the checklist should be customized to fit the unique needs of their region. Planners also should note that some tasks may occur concurrently and do not necessarily need to happen in the order listed.

Carrying out the steps of this checklist requires that one or more entities take the lead in assessing the project’s feasibility in a region and coordinating planning and implementation efforts. Although a state sexual assault coalition might be willing to take on this role, it is important to also explore other possible project leaders at the state and local level.

  • Assess the feasibility that a region could support and sustain a mobile SANE project. If a region has been identified from the start, completing the tasks below can help planners assess the feasibility of implementing the project.

    • Determine who will do the feasibility study.

    • Gather data from jurisdictions on the numbers of reported sexual assaults and examinations performed over a specific time period.

    • Identify areas that have a sufficient number of reports and examinations to attract local interest in the project.

    • Identify mechanisms the state or jurisdiction uses to pay for forensic medical examinations (similar to West Virginia’s Forensic Medical Examination Fund).

    • Consider how reporting and examination figures compare to the number of sexual assault victims seen by the local rape crisis center, if one exists.

    • Find out what procedures hospital emergency departments follow regarding sexual assault victims and the services provided to them. Also, assess the hospitals’ interest in sponsoring a mobile SANE project.

    • Determine if the following are present within a county or region:
      • A sufficient number of licensed medical facilities and SANEs.
      • Existing SANE programs.
      • Rape crisis centers.
      • Active sexual assault response teams (SARTs).

    • Consider how a region’s size, terrain, and seasonal weather conditions could affect the response time of SANEs and advocates.

    • Analyze the data collected to determine whether a region might be able to support the project, or to identify regions where the project might be successful.

    • Identify regional issues that could affect the project.

  • Invite input and participation from communities within the region. Gather together key stakeholders to assess their interest in and capacity to participate in the project.

    • Determine who will coordinate this specific effort. The coordinator(s) can collaborate with the local rape crisis centers to identify key stakeholders for the project.

    • Invite stakeholders to participate in a meeting. Request that rape crisis centers and SARTs assist in recruiting stakeholders.

    • Arrange a time and location for the meeting. Think about how to entice stakeholders to attend (e.g., by offering lunch or a stipend).

    • Consider using a facilitator to conduct the meeting who is not affiliated with stakeholders.

    • At the meeting, provide stakeholders with an overview of the project and an opportunity to comment on whether they think it would be practical and cost effective for their region. Give them a chance to provide input on what issues need to be resolved and what adaptations to the West Virginia model will be necessary. Find out whether communities would like to further explore the possibility of implementing the project and which specific stakeholders would like to be part of the planning process.

  • Work with community stakeholders to develop the project. Use both large, multidisciplinary forums and smaller committee meetings to address issues that need to be resolved and develop the implementation plan.

    • Identify who will coordinate development efforts.

    • Specify how the project will adapt West Virginia’s model to meet local needs (e.g., an advocacy program for victims presenting at local hospitals may already exist and need only be coordinated with the project).

    • Outline how the SANE program will operate and coordinate with hospitals and advocates.

    • Outline how the advocacy program will operate and coordinate with SANEs and hospitals.

    • Outline how the hospitals will be involved and coordinate with SANEs and advocates.

    • Seek the support of law enforcement and prosecution offices in promoting the project in local communities, particularly among hospitals.

    • Incorporate mechanisms in the plan for stakeholders, as well as victims served, to provide feedback on its strengths and challenges and on the quality and effectiveness of the examination process. Improvements to the project should be based on this feedback.

    • In working with stakeholders, identify factors for each component of the project (SANEs, advocacy, and hospitals) that may facilitate or impede project implementation and sustainability. Consider how best to build on the positives and overcome the challenges.

    • After a plan is complete, meet as appropriate to carry out the implementation process.

  • Secure funding and resources to support project implementation.

    • Coordinators and participating agencies should consider what is needed to implement the project. For example—
      • Personnel needs.
      • Needs related to meeting coordination, travel, and communication among stakeholders.
      • Recruitment and training needs.
      • Needs for equipment, supplies, and services (e.g., cell phones, pagers, an answering service, printing).

    • Determine additional funding required for these needs, if any. Also explore what can be done without additional funding and what existing resources the region has that might be useful.

    • Identify potential funding sources and apply for funding. Consider applying jointly with other entities if it will assist in planning and implementation or increase the likelihood of receiving an award.

    • If awarded funding, comply with funders’ requirements (e.g., to submit periodic reports).

  • Employ necessary personnel.

    • Determine the need for contractual versus salaried personnel. (What period of time will each be needed and for what specific tasks?)

    • Clarify how each position will be financed and identify the supervising/contracting agency.

    • Develop job descriptions and applications for each position.

    • Advertise positions, screen candidates, and hire qualified personnel.

    • Provide training and supervision.

  • Develop a written plan for implementation and sustainability and give all stakeholders a copy.

    • Compile the decisions made and tasks identified by community stakeholders and present them in the plan.

    • Include a tentative timeline for implementation.

  • Develop a basic structure for hospital administration of the project.

    • Identify the administrative party or host hospital for the project. Develop and execute a contract for the host hospital that outlines its responsibilities. Resolve any administrative or operational issues.
      • Work with participating hospital representatives to identify the most appropriate host hospital.
      • Resolve any related issues.

    • Develop and execute a memorandum of understanding (MOU) for participating medical facilities.
      • Involve hospital administrators who have the authority to make financial decisions in contract discussions.
      • Consider using an outside entity as a mediator in working out compromises and keeping negotiations moving forward.
      • Identify and resolve issues among hospitals.
      • Clarify the hospitals’ roles in—
        • Arranging for nurses to participate in the project.
        • Covering the cost of the project.
        • Seeking reimbursement for examinations performed.
        • Providing space for examinations in their facilities.
        • Providing necessary supplies and storage areas for evidence collected.
        • Contacting SANEs and advocates when patients presenting as sexual assault victims arrive at their facility.
        • Collecting data in these cases.

    • Outline in the MOU what hospitals will receive for their investment in the project.

    • Create a budget for the project (this task may go hand in hand with developing MOUs).
      • Identify project expenses.
      • Identify project income.
      • Consider what contributions are needed from involved agencies to develop a balanced budget.

  • Take steps to operationalize the SANE component of the project.

    • Develop SANE protocols that are compatible with all participating medical facilities.

    • Develop an on-call system for SANEs (and a backup system) that provides 24/7 coverage at participating medical facilities.

    • Identify examination space in all participating medical facilities where SANEs may conduct examinations.

    • Develop specifications for examination equipment and supplies to be purchased.

    • Procure and provide equipment and supplies to the participating medical facilities.

    • Develop a form to aid in the evaluation of evidence collection submitted for processing.

    • Assemble and distribute resource manuals to participating SANEs.

    • Recruit and train SANEs.
      • Develop job descriptions and applications for SANE nurses.
      • Develop SANE commitment agreements. Consider what would entice SANEs to sustain their participation over time.
      • Recruit nurses for SANE training sessions.
      • Identify the minimum number of SANEs needed and train at least that number.
      • Coordinate and conduct adult and pediatric SANE training sessions (consider back-to-back pediatric and adult training sessions).
      • Assist nurses in fulfilling their clinical requirements in a timely manner.
      • Secure written commitments from the newly trained SANE nurses in which they agree to participate in the project on an on-call basis.

    • Hold regular forums to allow SANEs to work as a team, do peer reviews, resolve problems, share promising practices, receive clinical supervision, and obtain continuing education and information about changes in the project.

  • Take steps to operationalize the advocacy component of the project.

    • Develop and execute an MOU for participating rape crisis centers.

    • Develop protocols for advocates to follow that are compatible with the participating rape crisis centers.

    • Develop an on-call system for advocates (and a backup system) that provides 24/7 coverage at participating medical facilities.

    • Recruit and train volunteer advocates.
      • Develop a recruitment brochure for the sexual assault advocate program. Consider what would entice volunteers to sustain their participation over time.
      • Recruit volunteers for training sessions.
      • Identify the minimum number of volunteers needed to serve as advocates for the regional SANE project and train at least that number.
      • Coordinate and conduct training sessions.
      • Train a number of advocates to provide ongoing training to future volunteers.
      • Secure written commitments from the new advocates in which they agree to participate in the project.

    • Hold regular forums to allow volunteer advocates to work as a team, resolve problems and share promising practices, receive supervision, and obtain continuing education and information about changes in the project.

  • Implement the project when all components are ready to be fully operational.

    • Seek positive publicity for the project to encourage more victims to seek care.

  • Sustain the project.

    • Complete the checklist tasks (customized as needed) to help ensure that each step of the planning process is geared toward producing a programmatically and fiscally sound project and that issues related to sustainability are considered.
    • Celebrate project successes and milestones.
    • Seek positive publicity to help maintain community support for the project.
    • Continue to evaluate the project’s effectiveness over time and, based on evaluation results, make changes necessary to improve the project.
    • Seek out additional funding and resources as necessary to maintain the project.
    • Encourage stakeholders to continue to meet as needed to discuss how to creatively deal with challenges as they arise. Keep asking, “What can we do now to make the project work?”

*The steps in the checklist are similar to the steps that FRIS took to develop the model project, as discussed in this document. However, they are not exactly the same because what communities need to replicate the project is different from what FRIS needed to do to research and develop the model project.