Assessing Project Feasibility
Not every rural region can support a mobile SANE project. Realizing this, FRIS identified factors that were critical to a region’s capacity to implement and sustain the project. Then it collected data and solicited feedback to identify areas that met the criteria.
Identifying Potential Service Areas
FRIS gathered three types of information to help identify which regions of the state could support the project.
First, the service area must have reported a sufficient number of sexual assaults and performed enough forensic medical examinations to attract local interest in the project and create the possibility of sustainability. Multiple sources were needed to get an accurate picture of the sexual assaults reported and the numbers of examinations conducted throughout the state. No one source could provide all the data sought. Hospital reports on the numbers of examinations conducted, for example, usually were different from reimbursement data and criminal justice reporting statistics.
FRIS studied data from the following sources to help identify potential service areas:
- West Virginia Prosecuting Attorneys Institute: This institute is the state’s agent for providing reimbursement to licensed medical facilities for the forensic medical sexual assault examinations they perform (with reimbursements paid from the West Virginia Forensic Medical Examination Fund).
- West Virginia Crime Lab: The crime lab processes sex crimes kits submitted for testing by law enforcement in the state.
- The state’s licensed medical facilities: Hospital emergency departments were asked to report the number of forensic medical sexual assault examinations they conduct annually, recognizing that not all examinations result in a sex crimes kit being collected.
Sexual Assault Response Teams are typically eager to promote SANE programs as a viable way communities can improve their response to victims of sexual assault. The teams in the region where the project was implemented advocated for their local hospitals to participate in the project and helped to recruit SANEs from their counties.
Second, FRIS gathered information from each county, including the number of licensed medical facilities and SANEs in each and its existing SANE programs, rape crisis centers, and sexual assault response teams (SARTs). Support for a regional mobile SANE project is often greater in areas where SANE programs, rape crisis centers, and active SARTs already exist. To some extent, communities that have these elements are aware that SANE programs lead to improved care for victims and increase the likelihood that the forensic evidence collected will aid in criminal investigations. Rather than being threatened by the idea of a regional project, SANEs in the local hospitals saw its potential to bring more stability, strength, and cost effectiveness to their work.
FRIS also considered how a region’s geographical size, terrain, and weather could affect response time. Travel in most regions of the state involves driving on mountainous roads that can be difficult to navigate during severe weather (e.g., rain, fog, snow, and ice).
Rural regions that lack SARTs, rape crisis centers, or SANE programs may be interested in implementing a mobile SANE project. They can start by gathering community stakeholders together to consider how to build their capacity to support such an effort. These stakeholders—the agencies involved in immediate community response to sexual assault—must first understand the importance of working together to serve victims and hold offenders accountable. Next, they must assess how well each discipline already responds to this crime, how well they work together, and what problems exist. With this information, stakeholders can collectively plan how they will tackle problems (e.g., by first establishing a formal SART that can support the establishment and success of a regional SANE program). One related resource being developed by the National Sexual Violence Resource Center through funding from OVC is the National SART Toolkit (contact the center at 877-739-3895 for development status). End Violence Against Women International is also creating resources on SARTs, including a guide for rural communities, through its On-Line Training Institute.
Third, FRIS hired a consultant to conduct a telephone survey of hospital emergency departments around the state to help clarify information gleaned from other sources. The consultant also gathered data on existing emergency department practices related to the forensic medical examination and hospital interest in a mobile SANE project. For each emergency department, the consultant attempted to connect with a nurse manager, clinical supervisor or charge nurse, or another responsible person who could accurately answer questions.
The survey revealed several issues that would affect project development. A severe nursing shortage in the state meant that the mobile SANE project would have to compete with other hospital on-call programs for nurses. In addition, many of the hospitals surveyed were part of a larger health care system, but were not networked locally. This would make working together a challenge for hospitals that were not in the same network. Lastly, many West Virginia hospitals lowered their expenses by contracting with out-of-state companies for their emergency department physicians. This fact undercut a common selling point of a SANE program: that it costs hospitals more for a doctor to conduct the examination and testify in court than it does for a SANE to do so.
When FRIS looked at the information compiled, one six-county region in north-central West Virginia clearly stood out as a potential service area for the project. This region was served by three rape crisis centers. Four of the six counties had SARTs. Each county had a licensed medical facility, and most had at least a few SANEs on staff. A sufficient number of examinations were performed and reimbursed in the region to provide a base of revenue for the project (through the state Forensic Medical Examination Fund).