How Evaluation Toolkits Can Help Sexual Assault Nurse Examiner Programs Assess Their Impact

Sexual Assault Nurse Examiner (SANE) programs have been implemented throughout the United States with the goals of providing enhanced victim care post-assault and improving the criminal justice response to sexual assault. In this study, NIJ-funded researchers examined how SANEs can use a practitioner-oriented evaluation toolkit to assess the impact of their programs.

June 11, 2018

In a SANE program, specially trained nurses provide comprehensive psychological, medical, and forensic services to victims of sexual assault. These nurses also work with various members of the criminal justice system to improve the response to victimization and increase prosecution of sexual assault cases. SANE programs have proliferated quickly, with more than 900 in existence by 2018.[1] However, their practice philosophy and implementation vary widely, and very few SANE programs have been rigorously evaluated by either practitioners or researchers.

To assist SANE programs in performing self-evaluations, in an earlier project, NIJ-funded researchers [2] created the SANE Practitioner-Oriented Toolkit (Toolkit). The Toolkit guides practitioners through the evaluation process from start to finish in seven steps. It begins with evaluation questions and ends with specific steps that help practitioners share their findings with other stakeholders and create action plans for change.

Researchers in a second NIJ-funded study set out to determine whether the Toolkit helps practitioners evaluate changes in prosecution rates in their jurisdictions, increase their knowledge of evaluation processes, create local action plans, and potentially shift definitions and solutions based on findings. To study these issues, the research team examined six SANE programs — two urban, two rural, and two midsized — as they used the Toolkit to evaluate themselves. In addition to the Toolkit itself, researchers provided technical support and assistance to the programs throughout the evaluation process, including group conference calls, phone consultations, and site visits. Each site consistently implemented all Toolkit steps, communicated with other participating SANE programs about their experiences, and used technical assistance provided by researchers.

Results of the study fell into two categories. First, researchers examined the substantive findings from the six program evaluations. One major finding was that the overwhelming majority of reported sexual assaults do not result in arrest and prosecution. The researchers reported 80 to 90 percent of cases in the evaluation sample were never referred by police to prosecutors or were not charged by the prosecutor’s office.

At each site considered individually, SANE programs showed no significant change in prosecution rates for sexual assault. But by aggregating data across the six sites for increased statistical power, researchers were able to observe a statistically significant effect: Compared with sexual assault cases processed before implementation of a SANE program, cases processed after implementation of a SANE program were almost 80 percent more likely to progress further through the criminal justice system, attaining a higher level of disposition.

The study’s second category of results concerned the Toolkit itself. With both qualitative data (field notes, interviews) and quantitative data (surveys, contact logs) collected from the six participating SANE programs, researchers showed that implementing the Toolkit resulted in many positive outcomes for the programs. Program staff became more knowledgeable about the evaluation process and expressed greater commitment to evaluation. Programs were able to apply their findings directly to make changes, either by bringing more law enforcement into their multidisciplinary teams or by using evaluation results to substantiate the need for more funding. The evaluation process also challenged participants’ perspectives on their programs and their own roles. For example, some staff thought very differently about their function in the prosecution process after learning how few cases ended in successful prosecution.

The findings of this study highlight the reasons that NIJ encourages programs to include an evaluation component — such evaluations can inform local practice, improve program functioning, and enhance responses to victims. Researchers also noted that SANE programs are only one of many stakeholders involved in the prosecution of sexual assault; there is much work still to be done to improve victim care and increase prosecution rates.

About This Article

The research discussed in this article was conducted by Rebecca Campbell, Stephanie Townsend, Deborah Bybee, Jessica L. Shaw, and Jenifer Markowitz. The study was supported by funding from the National Institute of Justice, grant number 2009-MU-MU-0002.

This article is based on the final report, “Implementation of a Sexual Assault Nurse Examiner (SANE) Practitioner Evaluation Toolkit” (pdf, 145 pages), January 2013, NCJ 240916.

Results of this study were published in a 2015 article Can a Workbook Work? Examining Whether a Practitioner Evaluation Toolkit Can Promote Instrumental Use", Evaluation and Program Planning.

Results were also published in a 2014 article "Evaluating the Legal Impact of Sexual Assault Nurse Examiner Programs: An Empirically Validated Toolkit for Practitioners", Journal of Forensic Nursing.

Cite This Article

National Institute of Justice, “How Evaluation Toolkits Can Help Sexual Assault Nurse Examiner Programs Assess Their Impact.” June 11, 2018,


[note 1] The International Association of Forensic Nurses listed 939 registered SANE programs in the United States on its website as of February 2018. This is a free, voluntary listing of programs and should not be viewed as a complete listing for all programs.

[note 2] Campbell, R., D. Bybee, J.K. Ford, D. Patterson, and J. Ferrell. Systems Change Analysis of SANE Programs: Identifying the Mediating Mechanisms of Criminal Justice System Impact (pdf, 26 pages) Final report to the National Institute of Justice, grant number 2005-WG-BX-0003, January 2009. NCJ 226497.

Date Created: June 11, 2018