# Presentation: 333842

## Making SANE Work:Operational Details

- Connie Monahan, MPH
- Statewide SANE Coordinator
- New Mexico Coalition of Sexual Assault Programs
- _[conniem@swcp.com](mailto:conniem@swcp.com)_
- 1-505-883-8020

## Objectives

- Describe operational details in developing and maintaining a SANE Program
- Describe the role, purpose and variations of SANE training
- Identify how SANE works within continuum of prevention
- ** An appendix with specific tools and information

## Traditional Agency Growth and Development Phases

- Introduction
- Exploratory, first steps, whoa kind’a shaky...
- Growth
- Initial, forget walking-we’re running now!
- Maturity
- Expanding, we know everything don’t we?
- Maintenance
- Sustaining, this wisdom stuff takes constant review doesn’t it...

## 1. Introduction or Exploratory

- We want a SANE program!
- Finding team members
- Identifying resources – what’s out there?
- Responsibility: who’s doing what?
- Choosing a model, a structure
- Working with anybody who’s willing
- One person will probably devote most of the energy; leader by presence

## Common pitfalls during Introduction

- Not looking at standards or what’s available
- Choosing the wrong model
- Ignoring the mistakes of others
- Not knowing what to ask
- Thinking a SANE program will fix everything
- Not thinking and planning from the victim’s perspective
- Not thinking of evaluation or measurement

## 2.  Growth or Initial

- Enthusiasm rules!
- Basic needs are identified
- Action steps are incremental and people expect progress and updates
- More team members recruited
- Basic training and cross-discipline training
- Protocols and procedures developed
- Everybody’s learning – team members and community

## Common pitfalls with initial Growth

- Understaffing, building the martyrs
- Starting without a 3 or 5 year plan
- One energetic person may be bull-dozing progress without full consensus
- Underestimating actual costs
- Setting goals too high
- Written protocols and actual practice may diverge and no one says anything
- Learning curves among members differ
- Change is fast; people aren’t totally informed...
- Not evaluating or measuring

## 3.  Maturity or Expanding

- We’ve done so much, let’s do MORE
- We’re experts now, we’ll take on pediatrics and domestic violence and arson and prevention....
- Because we’re the experts, we’ll use our own folks as instructors – they know it by *experience*
- We’re going to buy the newest fan-dangled, state of the art, hottest equipment ever
- New leaders, sometimes outsiders
- More staff = more work
- We know everything 

## Common pitfalls during maturity

- Thinking that other topics (child sexual abuse, DV) are same as sexual assault
- Failing to groom replacements
- One person may still be running the show and folks may be sabotaging efforts
- Failing to realize costs increase exponentially, not linearly
- Focusing on equipment, not staffing
- Failure to re-evaluate 3 or 5 year plan
- Burn-out: When does this stuff get easier?!

## 4.  Maintenance or Sustaining 

- Calm commitment and enrichment
- True sense of team
- With each internal member having responsibility
- Relationships with collaborators are active
- Second and third tier leaders with consistency
- Deep and broad knowledge
- Recognition by outsiders
- Concepts and mission internalized and institutionalized
- Balancing patient care and professionalism

## Common pitfalls with maintenance 

- Boredom, same stuff-different day
- Failing to re-invest in the program
- Failing to explore/discuss appropriate expansion
- The slippery slope of grant addiction
- Moving outside primary mission statement
- Stagnation or loss of leadership
- Failing to stay abreast of literature, of changes
- Not having a back-up plan for income

## Slide 12

## Developing a SANE Program

- First steps need to happen simultaneously
- Researching what and who is available
- Training, hiring and precepting of nurses
- Multi-Disciplinary Team (MDT or SART)
- Funding and in-kind support
- Supplies, equipment
- Necessary agreements and forms
- Operational details and specifics of the program: who, what, when, where...

## Operational logistics

- Start with the mission statement first!
- Sample:
- 	SANE Program serves sexual assault victims by providing prompt, objective, compassionate, culturally sensitive, and comprehensive medical treatment and forensic evaluation by advanced trained nurses who work within a coordinated community response.
- Mission statement will guide you thru the “why,” with prioritization of resources, and through problem cases.

## Operational Logistics

- Who, what, when, where, how...
- Patient population
- Adults/adolescents and/or pediatrics
- Other population catchments
- Location of exams
- 24 hour access that is safe/secure
- Coordinated with medical triage/EMS
- Space/supplies
- How to activate
- On-duty versus on-call nurses, advocacy
- Telephone, pagers, time allotment to respond...
- Medical Records – forms, storage, release
- Protocols - suggested minimum list **

## Operational Logistics

- MDT or SART
- Pick a name that identifies area/population
- Standardize time/place to meet
- Identify leader
- Core group
- District Attorney, police agencies, rape crisis, crime lab
- Expand as desired/needed
- First increase group IQ: who does what how
- SANE one-page description **
- MDT Critical Elements list **
- Work through sample problematic scenarios
- Formal cross-training

## Operational Logistics - $ 

- Funding and in-kind support
- Who are your possible sources?
- Institution/facility, other hospitals, medical society
- State – health dept, state police, crime labs
- City – mayor’s office, police, DA victim services
- Civic organizations, foundations, fund-drives
- What do you need to get started?
- Mission statement and/or elevator message
- Articulating the need: why bother/so what
- Itemized list of expenses and priorities
- 3 to 5 year plan

## Operational Logistics - $ 

- Cost analysis **
- Place – room, access, storage
- Equipment – camera, swab dryer, colposcope
- Disposable medical supplies
- Medications
- Office supplies/machines (fax, phone, computer)
- Victim supplies – clothes, toiletries, snacks, etc.
- Staffing – initial training, on-going development, administration/coordination
- Priorities for now and priorities for future

## Operational Logistics - $ 

- What agency will be paying for
- Program itself (equipment, coordinator, etc)
- For patient services
- Medical
- Forensic
- For the medical provider/SANE
- Case fee vs. on-call
- Dependent upon police report or not?

## Operational Logistics - Resources

- Researching what’s available/already out there**
- Professional organizations
- IAFN, ACEP
- Federal agencies
- OVC, VAWA, DOJ
- State guidelines
- State Coalition
- Department of Health
- Attorney General or District Attorneys
- Nurse Practice Act
- Crime Lab (s)

## Operational logistics - Leadership

- Medical director
- Program point person or coordinator
- Recruitment of potential SANE’s
- Qualifications of being a SANE **
- Interviewing tool **
- Job description with expectations
- What kind of nurses would you want as part of the team...

## Operational logistics – It’sa Job

- Sample Job Description **
- Contract vs. employee
- Privilege for non-facility nurses
- Shift
- Length of shift
- Number of availability and number worked per month
- Other Expectations
- Response time, liability insurance, monthly staff meetings
- Payment
- Minimum # of exams/year or other competency measure
- On-going professional development

## Operational Logistics - Training

- Initial SANE Training
- Meet minimum requirements as outlined by IAFN and US Dept of Justice
- Multi-disciplinary – police, crime labs, advocacy, attorney (defense/prosecution)
- Train to Sexual Assault Evidence Kit, SANE Medical Record, sexual assault laws, services provided, equipment and genital A&P...
- Problems with inter-state reciprocity
- Adult/adolescent vs. children

## Operational Logistics - Training

- New Mexico as example...
- Twice a year, generally spring and fall in Albuquerque
- Two consecutive Friday-Saturday-Sunday weekends
- $50
- Update 3-inch manual each time (subject to subpoena)
- Enrollment of 12 students per class
- Twelve instructors with one person as facilitator thru-out
- Review questions every morning and summary quiz
- One day for pediatrics; one day for laws/mock trial
- Nursing continuing education hours
- Certificate of Completion (≠ certification!)

## Operational Logistics - Training

- Training: Role and Purpose
- Create consistency in practice specific to medical treatment and evidence collection
- Model the MDT-SART collaboration
- Network individual nurses to each other
- Create the link between individual nurses and statewide coordinator, agency, and instructors
- Create a “culture” of SANE

## Operational Logistics – Precept

- Precept or clinical/hands-on requirements
- Normal exams
- Male and female
- Adults and pediatrics
- Equipment and Techniques
- Shadowing of actual cases
- Courtroom observation hours
- Precept requirements
- Individual SANE Programs vs. State Agency
- Mandated vs. recommended vs. RN experience
- New Mexico as example
- Genital Skills Lab day**

## Operational Logistics – On-going Development

- In-services as part of staff meetings
- Competencies and evaluations
- SANE-related conferences (VAW, child abuse)
- SANE Certification
- International Association of Forensic Nursing (IAFN) administers certification test 2x a year
- SANE – A
- SANE – P
- Recommended after 1 to 2 years practice
- Cost, renewal and membership

## Protocols 

- Nursing standards of practice
- Facility’s protocols
- Just start working !
-  Examples from state coordinator or other states
-  Reactive to specific problems
- Master/original with signatures and copy for easy access
- Have a system for reviewing/updating
- Realize it may be subpoenaed
- Do NOT want to conflict with Sexual Assault Evidence or rape kit directions...

## Medical Record

- Generic template medical record
- Supplemental forms as needed
- DFSA, Suicide, hands/feet, strangulation, etc
- Core components of the medical record that explains rationale**
- Data fields to be collected by SANE
- Storage and release of records
- Photographs – part of record or not?

## Outreach/Prevention

- Getting the word out about program
- One pager description and how to access **
- Schedule in-services with collaborators and users
- Prevention
- SANE is intervention
- SANE nurses become experts/leaders in their community by default...
- Coordinate with others in the continuum
- Refer to mission statement and be cautious of bias
- Examples in New Mexico
- Rural school program
- Healthy sexuality
- Coordination with the school abstinence program

## Appendices 

- Suggested Minimal Policies for New Mexico
- One page description of New Mexico SANE
- MDT Critical List
- Cost analysis of starting/maintaining SANE Program
- National resources for SANE
- Qualifications for being a New Mexico SANE
- Sample Interviewing Tool
- Sample New Mexico SANE job description
- Overview of New Mexico Genital Skills Lab
- Core Components of NM SANE Medical Record

## Thank
YOU!

- YOU!

## Thank you

Questions?

- Questions?