The Sexual Assault Nurse Examiner (SANE) program aims to provide specialized and coordinated services to victims of sexual assault during their first contact with the health care environment. The goal of the program is to provide safe and privacy-conscious treatment to very recent victims of sexual assault in a response that coordinates health care with counseling services, forensic collection, law enforcement, and prosecution.
The SANE program extends services to recent victims of sexual assault when activated by a referral from participating medical services, law enforcement, or other services. SANE Units are stationed at hospitals, likely to be primary contact points with victims of sexual assault. However, participating emergency rooms (ERs), police departments, and rape crisis centers contact the program to dispatch a SANE nurse and a rape crisis advocate, should there be none onsite.
The program guides patients through services including medical treatment, treatment for sexually transmitted infections (STIs), emergency contraception, contact with law enforcement, collection of forensic samples, and referrals to other services in a secure and private manner. This is done to provide services to the victim in a more environmentally appropriate manner, to address health care and law enforcement concerns, and to try to provide a swifter and less traumatic service delivery.
From referral, victims are assessed for their need for medical treatment. Depending on the victims’ medical needs, either a SANE nurse and rape crisis advocate can be dispatched onsite or the victim can be discharged to a SANE Unit, where a forensic exam can be conducted if desired. Additionally, the SANE nurse offers STI testing and treatment as well as emergency contraception. Finally, a police interview can be arranged if the victim desires before she (or he) is discharged, often with referrals to multiple services. If criminal proceedings are brought against a suspected perpetrator of a sexual assault, the SANE nurse who examined the victim can testify in court.
The Sexual Assault Nurse Examiner program, as the name suggests, relies heavily on SANE nurses, but it also requires the sustained involvement and availability of rape crisis advocates. The program requires the cooperation and widespread knowledge of its services among hospital ERs, law enforcement agencies, and prosecutorial services.
The SANE program aims to provide better health outcomes and to increase the proper forensic collection of data, and also to ultimately increase perpetrator prosecutions in cases of sexual assault. The program achieves this by offering a range of coordinated services adapted to sexual assault victims’ needs at the point of contact with health or law enforcement services, instead of regular ER services—which deprive the victim of the privacy she (or he) may require in such a traumatic situation. By offering these services in a victim-sensitive manner, the SANE program aims to increase the likelihood of their uptake, which should increase positive health outcomes for victims and increase law enforcement’s odds of intercepting and prosecuting perpetrators.
Crandall and Helitzer (2003) found that the Sexual Assault Nurse Examiner (SANE) treatment group had significantly more referrals than the control group. The average number of referrals for the pre–SANE group was 1.7, compared with 4.0 in the SANE group.
Time in Treatment
The amount of time that victims in the treatment group spent at SANE was significantly less than the time that the victims in the control group spent in the emergency department. The mean amount of time spent in receiving treatment was 49 minutes shorter for the SANE intervention group than for the pre–SANE group treated in the emergency department.
SANE patients more often accepted pregnancy tests (88 percent of the SANE group did, versus 79 percent of the pre–SANE group), pregnancy prophylaxis (87 percent, versus 66 percent), and treatment for sexually transmitted infections (97 percent, versus 89 percent). All group differences were statistically significant.
The treatment group had significantly higher levels of forensic examinations, with consent to forensic sample collection being given in 98 percent of cases, compared with 47 percent of pre–SANE cases. Evidence collection and microscopic evidence collection was also significantly higher for SANE patients than in the control group. Vaginal photography was also significantly higher (88 percent) in the treatment group that in the control group (8 percent).
Reports to Police
The rate of reporting to police was 46 percent in the pre–SANE group, and was significantly higher in the treatment group—with 67 percent of victims filing a police report.
The number of charges per cases, the proportion of cases presented to the grand jury, and the proportion of charges resulting in an indictment all increased significantly from pre–SANE to SANE cases. In addition, the conviction rate increased significantly, from 59 percent before SANE to 69 percent after SANE. There were no differences in the number of dismissals or acquittals. However, a significantly greater percentage of SANE cases resulted in jail time (46 percent before, versus 55 percent after). Also, sexual assault cases before SANE were sentenced to 1.2 years, versus 5.1 years of incarceration after SANE—a statistically significant difference.