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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

Working With Community Stakeholders

To Involve Hospitals in Mobile SANE Projects—
  • Build significant time into the process for each hospital to commit to the project, identify and tackle problems related to collaboration, and keep negotiations on a contract moving forward.

  • Seek help from local organizations and individuals (e.g., rape crisis centers, SART members, SANEs and other hospital clinical staff) on involving hospitals in the project.

  • Early in the process, identify and involve hospital administrators who have the authority to make financial decisions for their hospitals. Develop positive working relationships with at least one of these administrators from each hospital.

  • Use an outside mediator (the role FRIS played in West Virginia) to help move the process along. Left to themselves, hospitals may conclude that the hurdles of building a partnership are too great to overcome.

After the initial discussion, the large group of stakeholders met on several occasions to develop a plan for implementing the project. The group identified a goal date for project implementation, general issues that needed resolution, and a tentative timeline for task completion. Some stakeholders were also assigned to one of three subcommittees. The larger multidisciplinary group meetings provided a forum for discussing subcommittee recommendations and making decisions related to project implementation. But because key stakeholders, particularly those from the hospitals, were often not present, it was difficult to finalize decisions. Ultimately, numerous decisions related to project implementation had to be put on hold for several months until all the hospitals formally committed to the project.

The subcommittees were asked to work through discipline-specific issues, such as SANE program operation, hospital administration of the project, and coordination of victim advocacy.

The SANE committee, composed of FRIS staff and the SANEs from the four counties, made several critical recommendations:

  • Recruitment efforts should go beyond emergency departments to reach a more diverse representation of nurses.

  • A screening process for SANE candidates was needed.

  • Free training should be offered to SANE candidates in return for their signed contracts in which they agree to participate in the project. Participating SANEs should complete both adult and pediatric SANE training courses.

  • The project must be able to offer competitive wages to attract and retain nurses. West Virginia was suffering an acute nursing shortage, and on-call pay varied widely throughout the country, from no payment unless an examination was conducted to $3 per hour. In addition, SANEs were commonly paid $150 for conducting a forensic exam. Based on this information, the committee recommended $3 per hour on-call pay for SANEs and a flat SANE fee of $200 for each examination conducted. The flat fee would cover traveling to and from the service area, conducting the exam, and testifying in court if necessary.

  • A 12-hour on-call shift fit nurses’ typical work schedules. Two shifts a week was considered the maximum frequency for each on-call nurse.

  • At least 12 SANEs were needed to fill the on-call schedule.

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The advocacy committee was made up of FRIS staff and the directors of WAIC and HOPE, Inc. Each rape crisis center serves two counties in the four-county area. The centers already used volunteers in other areas of their programs and were eager to establish the advocacy component of the project. The grant allowed for the coalition to contract with each center to hire a part-time advocate coordinator. Through its initial work, the committee created job descriptions and devised a plan for recruiting and training advocates.

The hospital committee was composed of FRIS and representatives from the four interested hospitals: United Hospital Center in Clarksburg, Davis Memorial Hospital in Elkins, St. Joseph’s Hospital in Buckhannon, and Stonewall Jackson Memorial Hospital in Weston. Although they were not networked together, these hospitals were willing to collaborate on this project. The committee was responsible for getting the hospitals to agree on the terms of their participation. Arriving at consensus among the hospitals was complicated, due to several factors:

  • Decisions that hospital representatives made related to the project were subject to the approval of their CEOs.

  • It was difficult to gather representatives from all four hospitals together at the same time to discuss the project. FRIS had to work energetically behind the scenes to encourage the hospitals to participate in talks and negotiations on the terms of their collaboration.

  • These hospitals were competitors in a small market for patients and personnel, but they had to join together for this project. Contract negotiations among these unlikely allies required considerable time and effort.

  • Although the hospitals were pleased to be part of an improved response to sexual assault victims, they needed to be confident that the project would be a fiscally sound investment.