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

Creating a Strategic Plan

Implementing the Program

  • Provide an orientation to SANEs and volunteer advocates who have agreed to participate.

  • Develop SANE exam and treatment protocols that are compatible with the participating hospitals.

  • Develop a completion evaluation form for the State Crime Lab to use to evaluate sexual assault evidence collection kits submitted for evidence processing.

  • Develop advocate protocols that are compatible with the participating rape crisis centers.

  • Develop an on-call system for SANEs, along with a backup system, that will provide 24/7 coverage at all participating hospitals.

  • Develop an on-call system for advocates, along with a backup system, that will provide 24/7 coverage at participating hospitals.

  • Identify an appropriate space for conducting SANE examinations in participating hospitals.

  • About the Camera

    The project uses the Macro 5 SLR camera as an alternative to a colposcope. Cost was a factor in this decision, as only one of the hospitals had a colposcope and the project lacked the funds to purchase colposcopes for all participating hospitals. The camera cost approximately $800, compared to about $23,000 for a colposcope. It was believed that it would be better to standardize the use of the cameras across all hospitals and train SANEs to use them, rather than each hospital having different equipment and training SANEs in how to operate each piece. (See note 14 for recent information on the availability of the Macro 5 camera.)
  • Develop specifications for examination equipment to be purchased (e.g., medical storage carts and Macro 5 cameras).14

  • Procure and provide equipment, supplies, and forms to participating hospitals.

  • Assemble and distribute SANE resource manuals to participating SANEs. Recommended manuals include hospital protocols, extra forms, contact information for SANEs and other agencies, checklists of what to do, an information sheet for addressing the risk of sexually transmitted infections and pregnancy, and maps of the service areas of each hospital that show the locations of examination rooms and storage carts.

By far the most challenging component of planning this project was determining how to administer it across participating hospitals that were not in the same health care system or accustomed to working together. After searching for and not finding a model to guide its efforts, FRIS realized it had to create one. Fortunately, the region already had basic structures in place for SANE program operation, victim advocacy, and interagency coordinated response. Project planners needed only to adapt these structures to fit the mobile SANE project's parameters.

Resources for Sexual Assault Medical Forensic Examinations

Several resources exist for communities that want to build basic structures that support their capacity to care for sexual assault victims and collect forensic evidence from them. The Office on Violence Against Women developed A National Protocol for Sexual Assault Medical Forensic Examinations, which outlines the roles of forensic examiners in the examination process and also provides guidance on the roles of other responders, and the National Training Standards for Sexual Assault Medical Forensic Examiners, a companion to the protocol that provides a framework for the specialized education of health care providers who want to become sexual assault forensic examiners. The Sexual Assault Forensic Examiner Technical Assistance Project was also developed to disseminate the protocol and provide related technical assistance. In addition, the Office for Victims of Crime developed the SANE Development & Operation Guide to serve as a blueprint for communities that want to establish SANE programs.
  • The main task for those planning the SANE project was to determine how to effectively deliver services to patients at multiple sites on a 24/7 basis. In some instances, planners had to move away from traditional models of SANE program operation to ensure that the logistical details (e.g., nurse recruitment, wages offered, and on-call scheduling) would support the project and lead to its success.

  • Prior to project planning, rape crisis centers had provided advocacy services in some but not all of the participating hospitals. The centers' primary task for this project was to expand their coordination efforts to ensure consistent access to and provision of these services across all hospitals.

  • Although it was critical that local law enforcement and prosecution agencies supported the project and encouraged hospitals to participate, the project did not require any changes in the agencies' responses in these cases.

Using the strategic plan as a guide, FRIS and the counties involved spent a little more than a year implementing the West Virginia project.