The Effectiveness of Sexual Assault Nurse Examiner (SANE) Programs

Rape survivors who seek post-assault health care and medical forensic evidence collection from emergency rooms often do not receive basic services, wait long hours, and have evidence collection conducted by personnel that lack training and experience. Sexual Assault Nurse Examiner (SANE) Programs were created to alleviate these problems. This paper presents a brief summary of the structure and functions of SANE programs as they currently exist in the United States, and then reviews the empirical research literature on the effectiveness of SANE programs in three domains: psychological recovery of victims, forensic evidence collection and prosecution rates. This paper concludes with summary recommendations for future research and practice issues to help develop the most effective, evidence-based practices.

Because traditional medical care often leaves survivors feeling "re-raped," SANE programs have sought to provide care in an empowering setting that addresses survivors' emotional and medical needs. Although emotional care is a primary goal of SANE programs, there have been few studies that have systematically evaluated the psychological impact of SANE programs. The available literature is limited, but suggests that rape survivors perceive SANE nurses as helpful and supportive.

Another founding goal for many SANE programs was to improve the quality of forensic evidence collection relative to the methods traditionally used in hospital emergency departments.

The clinical case study literature suggests that SANE nurses are not only competent in forensic evidence collection, but they are actually better at it because of their extensive training and experience. Yet, clinical case reports, though remarkably consistent in their conclusions, do not provide definitive evidence of the effectiveness of SANE nurses in forensic evidence collection. & Empirical studies that directly compare the evidence collected by SANE nurses and physicians on objective criteria would better inform the debate over whether nurses are competent medical forensic examiners. To date, there have been only two such comparative studies conducted in the United States. Both studies found support for better evidence collection by SANE nurses. However, it is important to note that training and experience, not job title or professional degree, are the likely reasons behind these findings.

Finally, by meticulously documenting injuries and physical evidence, it is possible that SANE programs may increase prosecution rates in their communities. As with the literature on the quality of forensic exams, case studies suggest that SANE programs increase prosecution. To date, there has been only one study that included a direct comparison of legal outcomes for SANE cases versus non-SANE cases and found strong evidence that prosecution of sexual assault cases was higher in SANE cases.

From this body of work, it appears that SANE programs are having beneficial effects on rape survivors' psychological well-being and they are improving the prosecution rates of sexual assault crimes. However, such conclusions are tentative because most published studies have not included adequate methodological controls or comparisons to rigorously test the effectiveness of SANE programs. To address these research and practice needs, it is important that researchers and SANE program practitioners develop strong collaborative relationships.