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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

Implementing the Project

Upon its implementation in September 2005, the Mobile SANE Project immediately began functioning as FRIS and its community partners had envisioned.

Thoughtful Planning Paid Off

  • Participating hospitals were consistently able to provide sexual assault victims with SANE and advocacy services. By year’s end, 107 victims had been served through the project.

  • The Forensic Medical Examination Fund reimbursed hospitals for all 107 examinations conducted. This figure exceeded FRIS’s projection of 104 examinations reimbursable during the first year and was enough to ensure that the host hospital earned a positive financial return.

  • Positive media coverage helped increase community awareness of this project. For example, the press covered a celebration held a month after project implementation, during which several advocates and nurses gave uplifting testimonials about their project experiences.

  • Child sexual abuse victims were examined close to home for the first time because of the project. Before its implementation, child victims had to travel outside of the region for pediatric sexual abuse examinations.

  • Standardized protocols were used by the SANEs, advocates, and hospitals across the region. The planning that went into developing these protocols and getting people to follow them resulted in smooth delivery of services. Because the project was formally supported by hospital leadership, for example, emergency department directors, physicians, and nurses were generally responsive to SANEs regardless of whether or not they were on staff. Hospital staff also benefited because they could divert sexual assault cases to on-call SANEs and advocates, which left them free to help other patients.

  • The project promoted local and regional collaboration at many levels. Hospitals worked together to support, implement, and maintain the project. SARTs and rape crisis centers encouraged project development. The SANE program and rape crisis centers made sure the region had SANEs and advocates available 24/7. Hospital personnel contacted SANEs and advocates when victims of sexual assault arrived in their emergency departments, which led to victims receiving optimal service.

  • All participating hospitals made changes to their policies and practices in order to be involved in the project. Prior to project implementation, all protocols, forms, and evidence collection kits were geared for adult patients only. Hospitals now instituted a pediatric protocol and medical history form. Also, the data collection form that accompanies the kit was revised to ask for additional case information.

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Each Component of the Project Succeeded

  • The SANE program was a success due to several factors. The project had no significant problems recruiting nurses. With 13 nurses trained and participating in the project, a sufficient number of SANEs were available to cover the 24/7 on-call schedule. Although a modest turnover of SANEs occurred, filling these positions was not difficult. SANEs generally felt positive about their roles and believed the project supported their work. Participating SANEs functioned well as a team and were able to work through issues and problems among themselves. Having a project administrator who was a SANE proved to be invaluable. She provided backup numerous occasions, including times when more than one victim presented at a hospital. Quarterly SANE meetings, which the nurses were paid to attend, allowed the nurses to share experiences and best practices, and to obtain additional training.

  • The advocate component was equally successful, with 51 volunteer advocates trained and participating in the project. Because advocacy services were well coordinated with SANE services, more sexual assault victims presenting at local hospitals had access to advocate support than ever before.

  • Traveling across this mountainous region to provide timely on-call services had its challenges, but the SANEs found it to be manageable. They were able to depend on one another to resolve issues as they arose. For example, SANEs could contact each other if they needed to switch shifts due to weather-related problems such as a mountain pass being too icy to cross. The quarterly SANE meeting was also a useful forum for discussing issues such as how to deal with situations that affected their response time. Because advocates responded only to cases at hospitals within the service area of their local rape crisis centers, they encountered no new challenges related to response time.

The only glitch in project startup occurred on the first day of implementation. Not all nurses had completed the clinical preparation they needed for pediatric SANE competency by that time. A child presented as a sexual assault victim at a participating hospital on that day, and the nurse on call was one who needed further pediatric clinical experience. The project administrator was called in to conduct this examination. In hindsight, the project should have been 100-percent ready from day one.