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Regional Sexual Assault Nurse Examiner (SANE) Models. September 6, 2012. IHA-OAG Joint Goals on SANES. Double the number of fully-practicing SANES Establish a hospital-based SANE program in each of Illinois’ eleven EMS regions

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iha oag joint goals on sanes
IHA-OAG Joint Goals on SANES
  • Double the number of fully-practicing SANES
  • Establish a hospital-based SANE program in each of Illinois’ eleven EMS regions
  • 33 more nurses and 2 hospitals still needed to fulfill these goals by this fall!
  • Hospitals looking at options for regional SANE programs
9 6 webinar and 10 4 workshop provided by icahn grant
9/6 Webinar and 10/4 Workshop Provided by ICAHN Grant

Funding for this program is provided through the Medicare Rural Hospital Flexibility Grant program and supported by the Illinois Critical Access Hospital Network (ICAHN).

  • Grant-funded program requires “pre-survey”
pre program survey
Pre-program Survey
  •  Are you currently a sexual assault transfer or a treatment hospital under the SASETA law?

ANSWERS:  A.   Transfer hospital

B.   Treatment hospital

  • How many practicing SANES do you currently have?

ANSWERS:   A. None

B. 1-2

C. 3 or more

  • Are low volumes of victims presenting at your facility a concern for SANES to maintain skills?

Answers: A.  Yes          

B.  No

C.  N/A as we are a transfer hospital

  • Have you done any work on developing a regional plan for SANE services?

Answers: A.  Yes          

B.   No

regional sane models
Regional SANE Models
  • Shannon Liew, SANE Coordinator, Office of Attorney General Lisa Madigan
  • Dr. Pat Speck, DNSc, APN, FNP-BC, DF-IAFN, FAAFS, FAAN, will discuss the SANE model in Memphis
  • Connie Monahan, MPH, will describe New Mexico’s unique infrastructure for providing SANE services
  • Marlena Clary, BSN, RNC, SANE-A, SANE-P, will discuss the Columbia, SC program
sane program models overview

SANE Program Models Overview

Patricia M. Speck, DNSc, APN, FNP-BC, DF-IAFN, FAAFS, FAAN

Associate Professor and Public Health Nursing Option Coordinator, College of Nursing

University of Tennessee Health Science Center


The goal of this presentation is to introduce the learner to

  • The evidence for different models of SANE programs nationally, including possible IL models
  • The Memphis Model for Forensic Nursing care of sexual assault victims (c. 1973)
three types of programs cdc 1997
Three Types of Programs (CDC, 1997)
  • Commercial
    • May be private, for profit
    • Held to same regulations
  • Not-for-profit
    • Must make a profit to remain in business
  • Government
    • Increases program activity with policy/funding
    • Decreases program activity with policy/funding
commercial sane programs
Commercial SANE Programs
  • Characteristics
    • Obviously, need to make profit
    • Contract with hospitals or governments to provide forensic nursing care to the DV or SA community
    • Located in states where BON/Rules and Regulations allow
    • Will send SANEs to the hospital
      • Uses hospital resources
      • May carry luggage with necessary equipment, kits, chart, and cameras
      • Will leave consultant documentation for hospital
      • Pre SANE service negotiations mandatory
not for profit sane programs
Not-For-Profit SANE Programs
  • Characteristics
    • 501 c 3 paperwork
    • May be hospital, clinic or agency outside health care arena, e.g., CAC model
      • Contract with hospitals or governments to provide forensic nursing care to the DV or SA community
      • Pre SANE service negotiations mandatory
      • Will leave consultant documentation for hospital
    • Will send SANEs to the hospital in addition to seeing patient in the community
      • When present, will use hospital resources
      • May carry luggage with necessary equipment, kits, chart, and cameras
    • Located in states where BON/Rules and Regulations allow contractor relationships
    • Must also make a profit
government sane programs
Government SANE Programs
  • Characteristics
    • Locations variable
    • Usually funded with tax dollars
    • Memorandum of Understandingswith NFP or Commercial hospitals to provide forensic nursing care to the DV or SA community
    • Located in states where BON/Rules and Regulations allow
    • Must make a profit (or at least be budget neutral)
memphis rape crisis center formerly memphis sexual assault resource center
Memphis Rape Crisis CenterFormerly, Memphis Sexual Assault Resource Center
  • Government
  • Community-based
  • Funded by government grant
    • Initially HHS grant
    • After funding, City Council funded and agency folded into community and family services
    • After funding slashed, taken over by county health department; currently under County Victim’s Assistance
  • Most patients seen in community clinic by APNs
    • RNs must have supervision of practice in community
    • Public Health Department relationship continues 40 years
    • SART members respond together, remain present throughout evaluation, and leave together
memphis rape crisis center formerly memphis sexual assault resource center1
Memphis Rape Crisis CenterFormerly, Memphis Sexual Assault Resource Center
  • 2009 – Model program split after financial crisis into child and adult
    • Children – local hospital and CAC
    • Adolescents and Adults - Memphis Rape Crisis
      • Remained in the community
      • Continues to serve surrounding counties (80 miles diameter = possible 3 hour drive with law enforcement)
    • SART meets at hospital when medical condition warrants
      • Memorandum of Understanding
      • Privileges for all nurses associated with program - MOU
      • Consultant Notes left in hospital chart
      • Treatment recommendations
      • Medical Forensic chart remains with SANE
illinois program variations
Illinois program variations
  • Legislated funding directed toward hospitals
    • Hospital sponsored
      • Hospital affiliated clinics
        • Institutional designated areas
        • Satellite clinics
    • Hospital based
      • Emergency departments
        • Available rooms
        • Designated rooms
      • Areas away from emergency departments
        • Use hospital affiliated buildings close to the ED
        • Have even seen trailers in the ED parking lot in California!
new mexico sane and rural hospitals

New Mexico SANE and Rural Hospitals

Connie Monahan, MPH

Statewide SANE Coordinator

New Mexico Coalition of Sexual Assault Programs


who am i connie monahan
Who am I – Connie Monahan
  • Public health education and experience in NM for 20+ years
  • Worked on a NIJ funded research project evaluating the effectiveness of our state’s first SANE program
  • Executive Director of Albuquerque SANE (4 years)
  • State Coordinator for the SANE Programs at NM Coalition of Sexual Assault Programs since 2004
  • I am not a nurse
new mexico medical forensic response
New Mexico Medical-Forensic Response
  • New Mexico Sexual Assault Evidence Kit (SAEK)
    • NM has system for paying for medical/forensic exam funded by NM Human Services Dept and administered by our Coalition
    • Patient does NOT have to file police report for the exam
    • Time window is 5 days/120 hours for adults/adolescents and 3 days/72 hours for pediatrics 12 and under, with specialized response for non-acute pediatric exams
    • Accepted by both crime labs – State DPS and APD Metro; also accepted by FBI/Indian Country
    • Used by both hospitals and SANE Programs in NM

New Mexico SANE


SANE Program

Satellite SANE

Delayed Pediatric


with interest

new mexico sane programs
New Mexico SANE Programs

Albuquerque, 1996 400

Santa Fe, 1998 150

Las Cruces, 1999 100

Roswell , 2000 50

SAS of Northwest, 2003 130

Arise SAS/Eastern NM, 2004 120

Carlsbad, 2004 <10

Otero/Lincoln County, 2005 50

Grants/Cibola County, 2006 <10

Taos, 2010 <10

Silver City, 2011 <20

Hospitals without SANEs <60

(annual averages)

sexual assault exam options for rural hospitals
Sexual Assault ExamOptions for Rural Hospitals
  • Hospitals can perform the exam by a MD-PA-NP (i.e., advanced level provider) who may be “teamed” with a RN but not separated duties


  • Develop their own Sexual Assault Nurse Examiner (SANE) Program


  • Refer to nearby SANE Program or develop into a Satellite SANE
rural hospital response md pa or np default response
Rural Hospital Response – MD, PA, or NP(default response)


  • The average sexual assault exam can take 2 to 4 hours - burden on hosp. staffing esp with team response
  • Expected expertise with techniques/equipment is intimidating first time(s)
  • Expectation of legal proceedings is daunting


  • Helps hospital meet other standards
  • Incredible service to the community, professionals
  • Directions are in the SAEK
  • Sample “crash cart” list of needed supplies
  • Connection to advocacy
rural hospital developing their own sane
Rural HospitalDeveloping their own SANE

What the hospital is expected to do…

  • Lots of up-front and on-going work and costs
  • Takes about 8 to 15 months of preparation
  • Formal application indicating LE-DA-Advocacy support, hospital commitment, medical directorship, data, site visits
  • A team of at least three nurses and one medical director
  • Expectation of 15 to 20 adult/adolescent patients a year to ensure nurse competencies
    • “if you build it, they will come”
rural hospitals developing their own sane
Rural Hospitals Developing their own SANE

What our Coalition and I can do to help

  • SANE specific technical assistance/support, policies, training, miscellaneous forensic supplies…
  • Link the hospital with existing SANE Program with comparable hospital structure or community
  • The New Mexico Coalition of Sexual Assault Programs offers trainings/in-services for law enforcement, conference stipends for prosecutors, prevention materials, CSA prevention program for schools, sexual assault county data
rural hospitals and referral satellite
Rural Hospitals and Referral/Satellite
  • Referral
    • Informal process, not systemic
    • Transportation is predictable barrier
    • Advocacy becomes the critical piece in ensuring victim centered care (county mental health program, DA’s victim advocate)
  • Satellite
    • Formal MOU with another SANE Program/$ involved
    • Portable SANE kit ($3500), SANE can come to the hospital or patient can go to the nearby SANE Program
    • Community Sexual Assault Response Team (SART)
rural hospitals and referral satellite1
Rural Hospitals and Referral/Satellite
  • For Referral/Satellite, either Coalition or SANE Program coordinates in-service and materials to the hospital
    • Timeframe for response, consent, other parameters
    • How to activate, what to do while waiting
    • How to explain the SANE exam, what might happen
    • What to say to empower the victim, how victims might be responding/feeling
    • What are the local resources and co-responders
what nm has learned
What NM has learned…
  • Most rural/small hospitals do an informal referral, in crisis mode – generally works but co-responders aren’t satisfied with process.
  • We assumed that hospitals that signed up for the Satellite SANE would eventually take ownership of their own SANE program: that is not happening and it seems to be the hospital that stops the growth, not the community.
  • We have several communities where Law Enforcement and DA’s want a SANE Program and the hospital outright refuses; SANE Programs do not have to be hospital based but starting a SANE in a non-hospital setting is intimidating and doesn’t happen often
regional forensic nurse examiner program

Regional Forensic Nurse Examiner Program

How we respond to victims of sexual assault

Marlena Clary, BSN, RNC, SANE-A, SANE-P

where we came from
Where we came from………..

The Sexual Assault Nurse Examiner (SANE) Program

  • 1998-First SANE course offered in SC
  • 1999-Started as an ED based program at Palmetto Health Richland
    • SANE trained ED nurse’s performed exams (if working/available)
  • 1999-SART formed


    • Full time SANE coordinator
    • Private exam, interview and admin offices


  • Began seeing Pediatric patients
  • Expanded program to include sister hospital

Regional Forensic Nurse Examiner Program

  • A mobile forensic unit providing services to 7 area hospitals within a 6 county region
    • 2 Judicial Circuits
    • 3,633 square miles
    • Population of 765,685

Program details

  • 6 full time trained forensic nurse examiners, 1 full time coordinator
  • Memorandums of agreements with outside hospitals (5)
    • Contract employees at these hospitals
  • All patients 12 and younger seen at our pmain hospital
  • All documentation computerized, done contemporaneously in a web based database
  • Forensic record and photographs maintained by RFNE Program
mobilizing the fne
Mobilizing the FNE

When a patient presents:

  • Hospital contacts a centralized communication center
  • Communication center calls FNE on call
  • FNE triages call to determine:
    • If it meets criteria for a forensic exam
    • Prioritize which patient needs to be seen first if more than one patient and/or at more than one facility
  • FNE ensures facility has contacted local rape crisis counselor and law enforcement if applicable
  • FNE travels to that particular location to perform the forensic exam (response time 1 hr*)

How it’s done

  • Each nurse is outfitted with her own mobile cart equipped with a: laptop, digital camera, UV light, battery operated speculum light and all the other supplies needed to perform the exam.

Each hospital also has a locked medical equipment cart containing exam supplies and items specific to that particular hospital


Patient Care

  • Report from primary RN
  • Plan of care discussed with treating physician
  • Forensic evaluation, exam and evidence collection performed as indicated
  • Based on evaluation and exam findings provide medication and lab work recommendations to ED physician
  • Medications administered (by ED RN at outside hospitals)
  • Lab work processed (obtained by FNE during exam and submitted via ED RN at outside hospitals)
  • Discharge instructions and follow up recommendations provided (specific ED discharge instructions provided by ED RN in addition at outside hospitals)
additional responsibilities
Additional Responsibilities
  • Serve as a resource to other SANE programs throughout the state
  • Serve as a referral site for patients who live in areas without any trained forensic nurses
  • Provide education and training for:
    • Law enforcement agencies
    • Hospitals/medical staff
    • Community agencies involved in caring for victims of sexual assault
    • Solicitor’s office/judicial agencies
  • Active members of SART’s in all counties we serve
  • Collaborate with community agencies/organizations in prevention and education efforts

Palmetto Health Richland

Regional Forensic Nurse Examiner Program

5 Medical Park Drive

Columbia, SC 29201

Marlena Clary, BSN, RNC, SANE-A, SANE-P

Forensic Nurse Examiner

803-331-6720 (cell)

  • Register for follow-up workshop on October 4 in Springfield or Naperville:

  • If further questions, contact Barb Haller at IHA: or 630-276-5474 or

Shannon Liew at OAG: