Statewide SART/SANE Program—New Jersey

Overview
The Attorney General Standards for Providing Services to Victims of Sexual Assault (1998, rev. 2004) focuses on the needs and concerns of sexual assault victims in an effort to ensure the compassionate and sensitive delivery of services. By promoting a victim-centered approach to sexual assault, communities can make victim safety a top priority. These standards recognize obstacles to seeking help, respect the integrity and autonomy of each victim, protect the victim's confidentiality, and regard victim feedback as critical to an improved response.

The standards were codified in 2001. Each county is required to have SART and SANE programs. The law also established a unit within the New Jersey Division of Criminal Justice to oversee and coordinate the statewide program.

The following innovations are included in the standards:

• Anonymous reporting option.
• Exams available without law enforcement approval.
• Services provided at no charge to victim.
• Medications dispensed at time of service.
• Evidence held for 90 days when victims do not immediately report to law enforcement.
• Statewide standardized Sexual Assault Forensic Evidence kits (SAFE kits) and Drug Facilitated Sexual Assault kits (DFSA kits).
• Prosecutor-based SART and SANE programs.
• County SART Advisory Boards.
• Annual countywide SART training.
• Victim can go to any participating hospital regardless of jurisdiction.

Because the programs are based in the County Prosecutor's Offices instead of a primary hospital, most counties have more than one participating hospital. Currently, 54 hospitals participate in the program, donating space, medical screening examinations, and prophylactic medications for sexually transmitted infections and pregnancy.

The Division of Criminal Justice (DCJ) coordinates basic and continuing education for nurses. In addition to working with area nursing schools that run SANE courses, DCJ developed a partnership with the College of New Jersey to offer basic and continuing SANE education.

The New Jersey Board of Nursing and DCJ developed regulations for SANE practice and certification. Upon completion of extensive didactic and clinical education, a SANE can be certified as a Forensic Nurse–Certified Sexual Assault (FN–CSA).

Statewide SART/SANE Standards

• Statewide administration and oversight. County programs are supported by the Division of Criminal Justice SART/SANE Unit. The unit consists of the deputy attorney general and a program development specialist. Funding via the Federal Victims of Crime Act (VOCA) is administered from this office.

The attorney general appointed a SART/SANE Coordinating Council, which meets quarterly on the Statewide SART/SANE Program. DCJ hosts monthly meetings for SANE coordinators; quarterly meetings for SART coordinators; and quarterly meetings for sexual assault assistant prosecutors.

• Programs based in county prosecutors' offices. All 21 counties in New Jersey have a SART program, with SANE services available in 20 counties. The programs are housed within the county prosecutor's office. Each county is required to have a SART and SANE coordinator. Each county conducts its own annual SART training.

Each county SANE program maintains a cadre of SANEs who are, for the most part, independent contractors with the county prosecutors' offices and are paid on-call and case pay. Each SANE is required to maintain liability insurance. The county SANE coordinator holds monthly or bimonthly staff meetings and inservice trainings and is responsible for the clinical competency of the complement of SANEs.

• Participating hospitals. The county prosecutors' offices have individually entered into affiliation agreements with individual hospitals in their county. The hospitals agree to provide access to the county SANE program, space for a medical forensic examination, medical screening, and prophylaxis free of charge.
• County SART advisory boards. The programs are overseen locally by an advisory board established by the county prosecutor. The advisory board consists of the SART and SANE coordinators, the director of the local rape care program, personnel from area hospitals, and representatives from local law enforcement and the prosecutor's office. The advisory boards are required to meet monthly for the first year of operation, after which the meetings can be held either bimonthly or quarterly. Many counties continue to meet monthly after several years of operation.
• SART/SANE services. SART is victim driven. The victim is offered the services of the SART team, composed of a specially trained law enforcement officer, a rape care advocate, and a SANE. The victim is free to accept or decline any or all services provided by members of the team.

Each county has a centralized mechanism for SART activation. Some counties activate through central communications, 911, or the county sheriff's office, while others activate through the hospital emergency room. Team members must respond to the hospital within 1 hour.

Victims are offered a forensic examination up to 5 days after the assault. A participating hospital donates examination space and consumable supplies while the county prosecutors' offices or grant funds are used to purchase equipment such as alternate light sources and swab dryers. The county prosecutors' offices must supply the SAFE and DFSA kits. The prosecutors also supply hand-held cameras for photo documentation. DCJ provided colposcopes to all participating sites for visualization and documentation.

• Reporting/nonreporting. If the victim chooses to report the incident to law enforcement at the time of the medical forensic examination, law enforcement will take possession of all evidence collected. If the victim is unsure of reporting, then the evidence is held and labeled as "Jane Doe." There is no statute of limitations on reporting a sexual assault, but the law requires kits to be held for 90 days. Some counties hold kits indefinitely, while others destroy kits after a set time. Victims are notified prior to destruction of evidence.
• County victim-witness programs. The county SANE coordinator will provide the county victim-witness coordinator (who is also housed in the prosecutor's office) with the name and contact information for victims who reported to law enforcement at the time of the exam. This allows for early contact by the Victim-Witness Advocacy program.

Making the Idea a Reality
The process of implementing SART/SANE began with a 1996 amendment to New Jersey law requiring that standardized medical/forensic services be provided to victims of sexual assault. The onus of this task was placed on the state attorney general. The attorney general appointed a Sexual Assault Protocol Council, which was spearheaded by the Chief of the State Office of Victim-Witness Advocacy and consisted of county victim-witness advocates, rape care advocates, medical personnel, statewide victim service coalitions, DCJ, and the New Jersey Division on Women. In 1998, the protocol council developed and released the first Attorney General Standards for Providing Services to Victims of Sexual Assault. Statewide training was conducted by DCJ and other members of the protocol council on the new standards.

At the same time, the New Jersey State Legislature provided an appropriation to the Monmouth County Prosecutor's Office to begin a SANE program. In 1997–98, funding from the Violence Against Women Act was made available for two additional counties to begin a pilot SANE program. In 1999, VOCA funds were made available to all county prosecutors' offices for SART/SANE programs. In 2001, exhaustive Program Guidelines were developed and implemented.

Onsite technical assistance to the county prosecutors' offices was, and still is, provided by DCJ. By 2002, more than half of the counties in New Jersey had a SART/SANE program. In 2004, one SANE program located in a rural county was closed. The number of examinations requested was too low to allow the county to maintain a complement of competent nurses. The victims are referred to neighboring county hospitals that are less than 45 minutes away. In 2006, the last county, Essex County, will implement SART/SANE. This county is expected to have in excess of 450 requests per year for the sexual assault medical forensic examination.

Affiliation agreements with local hospitals and local rape care programs, as well as county protocols for providing SART services, are developed with the County SART Advisory Board. All affiliation agreements and protocols are reviewed biannually by DCJ to ensure compliance with the law, the standards, and the program guidelines.

Benefits to Victims
SART provides an immediate, compassionate response to sexual assault victims by trained professionals. In line with the goals of the program, SART minimizes secondary victimization and trauma. In line with quality evidence collection, which is paramount to criminal convictions, the New Jersey State Police Forensic Laboratory reports a 100-percent increase in the quality of SAFE kits with the implementation of SART.

Benefits to Victim Service Professionals
The County SART Advisory Boards have provided a forum through which victim service professionals can work with law enforcement, county prosecutors' offices, and hospitals in designing and implementing services for victims.

Funding for SART/SANE services is tied to compliance with the standards and the program guidelines. As such, SART has solidified the place of rape care services "at the table."

Evaluation Efforts
DCJ and the county prosecutors' offices are attempting to obtain as much information as possible about the effectiveness of the SART/SANE program. The following lists evaluation efforts:

• All victims are given an anonymous, self-addressed and stamped five-question survey to complete. The surveys are mailed to the New Jersey Coalition Against Sexual Assault and then given to DCJ.
• After each SART activation, SART members are given a survey about team interaction and hospital facilities to complete.
• The New Jersey State Police Forensic Laboratory provides a quality assurance checklist for all SAFE and DFSA kits evaluated. The results are compiled by DCJ and given to the county SANE coordinators.
• All 21 counties participate in the National Data Collection Project coordinated by Linda Ledray, RN, Ph.D., Director of the SANE-SART Resource Service in Minneapolis, Minnesota.
• An extensive evaluation by DCJ of all 2004 cases is underway. Principally, this evaluation will discuss prosecutorial outcomes in SANE cases. However, much more detailed information is being compiled into a database, which will enable discussion about the population serviced and the types of assaults and related injuries suffered in order to enhance services.

Lessons Learned

• Language choices. Communication and education are paramount to a well-functioning SART program. Each discipline uses different terminology. Within the victim services field alone, disagreement exists about whether to refer to a person who was the victim of sexual assault as a "victim" or a "survivor." Across three disciplines, the language issues are even more difficult. For the SART team to work well together, its members must agree on the definitions of the words they use and understand the necessity for certain word choices.
• Problems with activations and team interaction. Problems with activations or team interaction should be addressed immediately with the SART coordinator. The SART coordinator must take prompt action on any complaints. Most often, problems are evidence of the need to reeducate a particular team member or of a glitch in the process. Less frequently, these problems are indicative of a need to reevaluate the process. The SART coordinator should provide feedback to the individual who reported the problem as well as to the entire advisory board so that similar problems in the future can be resolved quickly.

It is important for all parties to recognize that official complaints against law enforcement are taken very seriously and can jeopardize the law enforcement officer's career. As often as possible, problems involving a law enforcement officer should be handled informally.

• Funding. Although the New Jersey program is quite fortunate in receiving VOCA funding, competition for funding in New Jersey is increasing. For three consecutive years, grants to the county prosecutors' offices have been cut. These cuts have not affected the core program, but they have strained its resources. Anticipated cuts will affect services. Dedicated funding is necessary for a sustainable and healthy program and is a worthy objective for federal, state, and local governments.
• SART/SANE coordinators. DCJ funds up to 5 hours per week for a SART coordinator and 16 hours per week for a SANE coordinator. When funding was initially offered for these programs, it was the responsibility of the county prosecutor to pay for the SART/SANE coordinator position. Several counties could not afford this so grant funds were approved for these positions. Counties with more than 50 cases per year warrant a full-time SART/SANE coordinator. Counties with more than 30 cases a year need a SANE coordinator to work more than 16 hours per week. Several county prosecutors' offices have used public funds to employ a full-time SART/SANE coordinator. DCJ is working with the counties to improve this situation.
• Backup for SANE coordinators. Turnover of SANE coordinators is not high, but the resignation of a SANE coordinator can be devastating to a program. In the past, county programs have shut down when a SANE coordinator resigned. For this reason, procedures for interim acting SANE coordinators were implemented.

SANE coordinators are also training another county SANE to fill in for holidays, vacation, and sick leave. SANE coordinators also work with neighboring counties to provide backup coordinator coverage.

• Nursing shortages. New Jersey has been experiencing a severe nursing shortage for the past 5 years. As a result, hospitals and nursing agencies are paying premium hourly rates for nurses. These hourly rates, coupled with signing bonuses and other incentives, are making it difficult to retain nurses or entice existing SANEs to take more on-call time. Many county SANE coordinators are on call several hundred hours per month.

Many county programs that had set no minimum requirements for on-call time had trouble covering the schedule. Most counties are now modifying agreements to require a minimum number of on-call shifts per month plus holiday coverage.

• Emergency room physicians. Because the SANE program has been in existence in most counties for more than 2 years, problems are now arising when no SANE is on call and emergency room physicians are being called upon to conduct the medical forensic examinations. Physicians have refused outright to do the examination under the premise that they are not specially trained. Several counties are working with local hospital administrations to resolve this problem because the hospital must provide medical care and collect evidence when a sexual assault victim presents to the emergency department. Clarification of these requirements from the outset will alleviate these problems.
  

Contact Information
New Jersey Department of Law & Public Safety
Division of Criminal Justice
Richard J. Hughes Justice Complex
25 Market Street, P.O. Box 080
Trenton, NJ 08625–0080