Debra Patterson

The effectiveness of sexual assault nurse examiner (SANE) programs: a review of psychological, medical, legal, and community outcomes.

In sexual assault nurse examiner (SANE) programs, specially trained forensic nurses provide 24-hour-a-day, first-response medical care and crisis intervention to rape survivors in either hospitals or clinic settings. This article reviews the empirical literature regarding the effectiveness of SANE programs in five domains:(a) promoting the psychological recovery of survivors, (b) providing comprehensive and consistent postrape medical care (e.g., emergency contraception, sexually transmitted disease [STD] prophylaxis), (c) documenting the forensic evidence of the crime completely and accurately, (d) improving the prosecution of sexual assault cases by providing better forensics and expert testimony, and (e) creating community change by bringing multiple service providers together to provide comprehensive care to rape survivors. Preliminary evidence suggests that SANE programs are effective in all domains, but such conclusions are tentative because most published studies have not included adequate methodological controls to rigorously test the effectiveness of SANE programs. Implications for practice and future research are discussed.

Prosecution of Adult Sexual Assault Cases: A Longitudinal Analysis of the Impact of a Sexual Assault Nurse Examiner Program

Most sexual assaults are never reported to law enforcement, and even among reported cases, most will never be successfully prosecuted. This reality has been a long-standing source of frustration for survivors, victim advocates, as well as members of the criminal justice system. To address this problem, communities throughout the United States have implemented multidisciplinary response interventions to improve post-assault care for victims and increase reporting and prosecution rates. One such model is the Sexual Assault Nurse Examiner (SANE) program, whereby specially trained nurses (rather than hospital emergency department [ED] physicians) provide comprehensive psychological, medical, and forensic services for sexual assault victims. The purpose of this study was to examine whether adult sexual assault cases were more likely to be investigated and prosecuted after the implementation of a SANE program within a large Midwestern county. A quasi-experimental design was used to compare criminal justice system case progression pre-SANE to post-SANE. Results from longitudinal multilevel ordinal regression modeling revealed that case progression through the criminal justice system significantly increased pre- to post-SANE: more cases reached the “final” stages of prosecution (i.e., conviction at trial and/or guilty plea bargains) post-SANE. These findings are robust after accounting for changes in operation at the focal county prosecutors’ office and seasonal variation in rape reporting. Implications for policy and practice are discussed.

The Impact of Detectives’ Manner of Questioning on Rape Victims’ Disclosure

Research has documented that few reported rapes are prosecuted by the legal system. The purpose of this study is to explain how the interactions between victims and detectives can strengthen or weaken the investigation itself. Twenty rape victims were interviewed to examine how law enforcement detectives’ manner of questioning affects rape victims’ level of disclosure. Using qualitative methodology, the results show that the detectives’ manner of questioning can play a role in victims’ disclosure. Detectives using a gentle manner of questioning with victims can help produce stronger victim statements and thus build stronger cases for prosecution.

Adult Sexual Assault Survivors’ Experiences With Sexual Assault Nurse Examiners (SANEs)

Sexual assault survivors often feel traumatized by the care received in traditional hospital emergency departments. To address these problems, Sexual Assault Nurse Examiner (SANE) programs were created to provide comprehensive medical care, crisis intervention, and forensic services. However, there is limited research on the actual experiences and emotional impact of sexual assault survivors who seek treatment from SANEs. This qualitative study examined twenty rape survivors’ experiences with forensic nurse examiners of a Midwestern SANE program. Findings suggest that SANEs provided survivors with care and compassion, clear explanations, and choices. Taken together, these positive experiences were perceived as “humanizing”. However, some survivors perceived forensic nurses as hurtful when they were not provided with choices, explanation, and/or acted cold and distant. Implications for future research on SANE care and practice are discussed.

Using Ecological Theory to Evaluate the Effectiveness of an Indigenous Community Intervention: A Study of Sexual Assault Nurse Examiner (SANE) Programs

In recent years, there has been renewed interest among community psychologists in indigenous interventions, which are programs created by local practitioners (rather than researchers) already rooted in their communities. Indigenous interventions have strong ecological validity, but their effectiveness is often unknown because so few are rigorously evaluated. The goal of this project was to use Kelly and Trickett’s ecological theory as a conceptual framework for evaluating an indigenous intervention and its mediating mechanisms of effectiveness. The focal intervention was a midwestern Sexual Assault Nurse Examiner (SANE) program, which provides post-assault medical care, crisis intervention, and medical forensic exams for sexual assault survivors. Prior studies of SANE programs have suggested that these interventions may help increase sexual assault prosecution rates. In this case example, we used a mixed methods design to determine if this program contributed to increased prosecution rates, and if so, why. Based on qualitative interviews with key stakeholders, we found substantial evidence for the Principle of Interdependence such that the SANE program strengthened the interconnections between the legal and medical systems, which contributed to increased prosecution. The intervention was effective in these outcomes because it promoted Cycling of Resources throughout the systems and fostered Adaptation of new roles for legal and medical personnel. Moving beyond this specific case example, this paper also examines cross-cutting advantages and struggles of using an ecological approach in the evaluation of indigenous community interventions.

The Problem of Untested Sexual Assault Kits Why Are Some Kits Never Submitted to a Crime Laboratory

Victims of sexual assault are often advised to seek postassault medical care to have a forensic exam, which includes evidence collection (termed a sexual assault kit [SAK]). After the exam, law enforcement personnel are supposed to submit the SAK to a crime laboratory for analysis. However, recent media reports suggest that in many communities throughout the United States, thousands of SAKs are left untested. Few studies have examined the rate at which law enforcement submits SAKs to crime labs or the factors that may predict them to do so. Thus, the purpose of this exploratory study is twofold: (a) to examine the percentage of SAKs law enforcement submits to crime labs in cases in which a sexual assault nurse examiner (SANE) performed the exam with adult victims and (b) to explore whether assault and law enforcement characteristics predict whether SAKs are submitted to a crime lab. This study found that only 58.6% of the SAKs were submitted to the crime lab within a large Midwestern county. Using binary logistic regression, this study found that kits were significantly as likely to be submitted when there were documented physical (nonanogenital) injuries compared with kits that did not have documented physical injuries. In addition, kits that were handled by a law enforcement agency that had a high level of engagement with the SANE program were significantly as likely to be submitted as law enforcement agencies with a low or medium level of engagement. Kits were significantly less likely to be submitted when victims cleaned themselves after the sexual assault (e.g., bathing). No association was found between kit submission and the victim–offender relationship, suspected drug-facilitated sexual assault, anogenital injury, and when the victim consumed alcohol or drugs before the assault. This article concludes with a discussion of the implications for research and practice.

A comparative study of the prosecution of childhood sexual abuse cases: the contributory role of pediatric Forensic Nurse Examiner (FNE) programs

Abstract This study used a rigorous quasiexperimental design to compare prosecution outcomes for childhood sexual abuse (CSA) cases examined in a pediatric Forensic Nurse Examiner (FNE) program (the “intervention group”) (n = 95) to a comparison sample of CSA cases examined by non‐FNE medical professionals prior to the inception of the FNE program (the “comparison group”) (n = 54). The types of cases in the intervention and comparison groups were different such that the FNE program had significantly more cases with younger victims where it was unknown or ambiguous whether they had penetration and/or fondling. Multivariate logit modeling was used to explore what factors predict legal case outcomes. Prosecution rates were significantly higher in the FNE group as opposed to the comparison group. In addition, cases with older victims who sustained penetration were the most likely to be prosecuted. Implications for forensic nursing practice are discussed.

Defining the boundaries: how sexual assault nurse examiners (SANEs) balance patient care and law enforcement collaboration.

Abstract Forensic nursing is multidisciplinary in nature, which can create tensions for practitioners between their responsibilities to patient care and collaborations with law enforcement and prosecutors. Because there are compelling reasons grounded in both nursing theory and legal precedent to maintain separation, there is a pressing need to understand how sexual assault nurse examiner (SANE) programs successfully negotiate these potentially conflicting roles. The purpose of this study was to examine how SANEs define their work with their patients, how they collaborate with law enforcement, and how they negotiate roles differentiation. As part of a mixed methods evaluation of a community‐based SANE program, qualitative interviews were conducted with forensic nurses regarding their interactions with patients and members of the legal community. Results indicated that a strong patient care practice had positive indirect effects on victims’ participation in the criminal justice system. Implications for forensic nursing practice are discussed.

The Impact of Sexual Assault Nurse Examiner (SANE) Program Services on Law Enforcement Investigational Practices A Mediational Analysis

Sexual assault nurse examiner (SANE) programs can be a vital resource to victims and the legal community. This study examined how police may use SANE services during the investigation phase and how this involvement may affect whether a case is forwarded by police to prosecutors. Police reports (N = 343) of adult sexual assault cases in three midwestern law enforcement agencies were content-analyzed to capture the nature of SANE involvement in the investigation, the specific investigatory steps taken in each case, and the referral outcome. When the victim had a medical forensic exam, police collected more kinds of other evidence to support the case, which was associated with increased likelihood of case referral for prosecution. When SANEs conducted a suspect exam (i.e., a forensic examination of the suspect’s body), police were more likely to collect other kinds of evidence and more likely to interview the suspect, both of which were associated with increased likelihood of case referral.

Methodological Challenges of Collecting Evaluation Data from Traumatized Clients/Consumers: A Comparison of Three Methods.

This project integrates elements of responsive evaluation and participatory evaluation to compare three evaluation data collection methods for use with a hard-to-find (HTF), traumatized, vulnerable population: rape victims seeking postassault medical forensic care. The first method involves on-site, in-person data collection, immediately postservices; the second, telephone follow-up assessments, 1 week postservices; and the third, private, self-administered surveys completed immediately postservices. There are significant differences in response rates across methods: 88% in-person, 17% telephone, and 41% self-administered. Across all phases, clients gave positive feedback about the services they received and about all three methods of data collection. Follow-up analyses suggested that nonresponders did not differ with respect to client characteristics, assault characteristics, or nursing care provided. These findings suggest that evaluations with HTF service clients may need to be integrated into on-site services because other methods may not yield sufficient response rates.