5 Key Concepts of SANE Care

 

Dear Sexual Assault Service Providers,
I am sending you this information with the 5 Key Concepts of SANE care in mind. Those key concepts
are:
1. Patient-centered care
2. Trauma- Informed care
3. Evidence-based practice
4. Multidisciplinary team approach
5. Recognizing community uniqueness
See OVC SANE Program Development and Operations Guide
https://www.ovcttac.gov/saneguide/introduction/building-a-theoretical-framework-for-sane-practice/

1. Patient-centered care- Realize that providing care during a pandemic adds significant stressors
to an already stressful event. In addition to dealing with their own assault patients may be
worried about family members at risk or have financial stressors that are causing distress.
a. Anticipate potential situations that might decrease access to care:
i. Strict visitor policies that might limit support persons. Many hospitals are
limiting visitation to only 2 visitors per patient. Find out now if that will limit
access for advocates.
ii. Payment issues. It is an ongoing struggle to make sure patients are never billed
for their exams. As hospitals struggle to keep up with high volumes of patients,
make sure your patients know what to do if they receive a bill after an exam.
Plan to be more aggressive about follow-up calls to check on patients.
iii. Don’t be afraid to slow the process down and take the time to reassure patients.
2. Trauma- informed care- The pandemic is causing extreme levels of stress in many people. Add a
history of previous trauma and a new trauma and you may have patients who are displaying
increased symptoms or may be more easily triggered.
a. Be aware that stress can trigger other chronic health concerns
i. Patients may be self-medicating with alcohol and drugs
ii. Trauma nightmares may become more frequent and sleep more interrupted
iii. Hotlines may be getting more calls from people with histories of previous
trauma

3. Evidence- based practice – We should be making decisions based on good scientific evidence. At
this point in the epidemic we do not have all of the answers.
a. What we know about the COVID-19
i. Spread by droplet
ii. Best protection is good hand washing and social distancing
b. What can you do to reduce the risk to you and your patients?
i. Don’t come to work if you are sick

ii. Wash your hands -20 seconds of scrubbing with soap and water
iii. If you use hand sanitizer – wet all surfaces of your hands and rub until they are
dry.
iv. Get a flu shot if you have not already been vaccinated
v. If you have a chronic condition such diabetes or heart disease you may want to
talk to your health care provider about potential risks if you are responding to a
hospital.

4. Multidisciplinary team approach – We have never done this work in a vacuum and that does not
change during an epidemic.
a. If you decide to make changes to your response protocol make sure you notify and get
input from all team members.

5. Recognizing community uniqueness- Each SANE program, Advocacy Program and SART will have
specific needs that must be addressed.
a. Below I am going to describe what we are planning for Utah County. Many of you may
not be able to duplicate our process, but hopefully this will give you some ideas to
discuss with your SART about how to prepare as the epidemic hits our communities. You
may have resources that others do not have. Don’t be afraid to think out of the box.
Finally, what I have written is this document is based on my knowledge and experience. It is not legal
advice, medical advice or any type of mandate from UCASA. Stay up to date on recommendations from
state and local officials. Work closely with your SANEs if they are hospital based and work closely with
your hospitals if you are community based. Be prepared that things could change rapidly.
Here are some trusted sites of information:
Utah Health Department https://coronavirus.utah.gov/
Centers for Disease Control https://www.cdc.gov/coronavirus/2019-ncov/index.html
National Sexual Violence Resource Center -Disaster Preparedness

https://www.nsvrc.org/projects/preventing-sexual-violence-disasters/sexual-violence-disasters-online-
special-collection/disaster-preparedness-resources

Here are the steps we have started to take for Wasatch Forensic Nurses in Utah County. Nothing is
finalized and I am sharing this so you can see what kinds of things we considering.
1. We are concerned that emergency rooms may become overcrowded with infected patients.
2. We have identified an alternative site for care and are seeking permission from the Gappmayer
Clinic to use their exam room to provide medical forensic exams 24/7 if the EDs become
unmanageable.
3. We will need to determine a contact person at all of the Utah Valley hospitals to keep informed
of room availability.

4. If we need to use the clinic, we will need to notify law enforcement about contacting WFN
before they send a patient to any location for an exam.
5. Nurses will need to be able to screen sexual assault patients before they are sent to the clinic.
Screening is important for both potential COVID-19 infection and medical conditions that would
make it inappropriate to be seen in a clinic setting ex. Unconsciousness, bleeding. Unless nurses
have the proper infection equipment patient with the virus should be seen in a hospital setting.
Remember the medial needs of the patient are always the first priority.
6. Advocate will be notified to respond to where the patient is being seen.
7. Other things to consider – How will you provide supplies and medications if you are seeing your
patient in a different location.? Is your alternative site safe at night and handicap accessible?
8. We have not thought of everything and going through a practice run might help identify gaps in
your plans.

Please take care of yourself and try to eat right and get plenty of rest. This may take a few weeks or
months to completely resolve and we want you safe and healthy for the long run. Remember you do
amazing work every day and make an incredible difference in the lives of survivors. Feel free to reach
out to UCASA if you need help or support.

Susan Chasson
Statewide SANE Coordinator
susan@ucasa.org