The advent of Sexual Assault Nurse Examiner and Sexual Assault Forensic Examiner (SANE/SAFE) programs has resulted in the increasing involvement of clinicians in the community response to victims of sexual violence. More than 750 programs now exist, according to the International Association of Forensic Nurses’ program registry. However, even as SANE/SAFE programs continue to be the norm in many parts of the US and Canada, their general health and sustainability isn’t a given. Many programs open to great anticipation only to quietly close a year or two later. Some programs are able to keep their doors open to patients, but may have problems responding consistently due to inadequate staffing. What follows are some tips to consider in making sure your own community’s SANE/SAFE program stays healthy and sustainable for the long term:
- Invest in people first. I have visited programs around the country and talked with countless nurses asking questions about how to raise money for a new colposcope or camera system. For many programs, however, the money really needs to be spent on the clinicians staffing the program. Investing in clinician education, call-pay and occasional pay raises are the kinds of investments that can make a real impact on program health and patient care. Most patients won’t see a difference if their care includes photographs with a $800 camera or an $8,000 camera system. However, they may benefit greatly from a clinician who has had the benefit of recent clinical education or networking with colleagues at conferences like EVAW’s annual conference or the IAFN Scientific Assembly. And with staff recruitment and retention being one of the most common challenges for SANE/SAFE programs, it’s important to remember that when clinicians feel valued and invested in they are more likely to stay on the staff roster.
- Keep the focus on healthcare. SANE/SAFE programs are clinical programs, run by licensed healthcare providers who attend to the health and well being of patients who present with a chief complaint of sexual assault. They may also collect the sexual assault evidence collection kit, should the patient so choose. When SANE/SAFEs maintain this clinical focus, rather than shifting into an investigative role, patients have better health outcomes and the criminal justice system ultimately benefits (PDF). Moreover, programs may be more likely to retain (and obtain new) healthcare dollars for program support. Hospitals that see their SANE/SAFE program as integral to the health of the communities they serve, rather than as an adjunct to law enforcement are more likely to continue providing support.
- Don’t run the program like a hobby. You would never dream of running a home health program or hospice nursing service without policies and procedures, staff evaluations and other structural components that ensure that the program is consistent in its operations and maintaining the highest standards of care. So make sure your program also has these fundamental building blocks in place (and ensure that they are regularly reviewed and updated as needed).
- Develop a more accurate definition of success. While it is appropriate to examine the impact of SANE/SAFE programs on the criminal justice system, court outcomes are not a good way to measure program success. There are many reasons cases aren’t prosecuted or result in acquittals, and most have nothing to do with the quality of the SANE/SAFE exam. Clinicians who judge the success of their intervention on the number of guilty verdicts that come back in their cases can become frustrated and disheartened. As healthcare providers your markers for success should be measured in healthcare and patient impact terms. Are x percent of your patients receiving ______ (fill in the blank: advocacy services, emergency contraception, HIV prophylaxis, etc.)? Are you reaching a broad group of patients that’s reflective of the community you serve? Do patients have positive feedback about your program when they talk with advocates and other victim service providers? Do patients get referred to your program by previous patients? Identifying relevant markers of success allows programs to see their impact. It also enables them to better craft arguments for funding support that keeps programs running.
SANE/SAFE programs serve a unique role in the patient care arena, but their sustainability depends on many of the same key components as most other healthcare services. What I’ve described above are not the only issues that impact sustainability, but they are some of the most important, and an excellent place to start. I hope this gives you something to consider as you examine the challenges your own SANE/SAFE program may be facing. But I’d love to know—what are some of your recommendations for program health?
Jenifer Markowitz is the Medical Advisor at AEquitas: The Prosecutor’s Resource on Violence Against Women. She served as project manager for the National SANE Sustainability Technical Assistance Project at the National Sexual Violence Resource Center, and continues working as a consultant on the next phase of that project, in conjunction with the International Association of Forensic Nurses. In her free time, you can find her at her personal blog, Forensic Healthcare Online.