Collaboration in the Facility Where Care is Provided

There may be opportunities for the SANE program management and staff to work with other departments within the facility to assure that these standards are being met and that patients have the response necessary to ensure that they are treated compassionately and in a trauma-informed manner. 

1. Triage/intake staff should all be aware of the steps necessary for activation of the SANE (if there is an on-call or call-in system involved). Triage staff should ensure that the patient has a private, safe place to wait, if necessary. Patients with a complaint of sexual assault should be treated as emergency patients and triaged accordingly. Triage staff should be aware that their role is not to investigate the sexual assault (questions should be limited in this area), per jurisdictional protocol. Triage staff should be aware that law enforcement are not to be notified as a matter of course, unless the patient is requesting that notification be made from triage. 
2. ED staff nurses should also be aware of the medical screening procedure for sexual assault patients and any duties that the ED staff is responsible for in providing for emergency treatment needs of the patient while addressing the need to preserve forensic evidence.
3. ED physician staff should also be aware of their role in the care of the patient who reports sexual assault for medical screening, acute injury assessment, intervention, as needed, and the exam protocol. ED physician staff may also be available to consult when the patient's needs exceed the level of care the SANE is able to provide. 
4. Child abuse pediatricians, when available, may be able to care for the pediatric/adolescent populations. There should be protocols in place to assess the need for an acute or chronic child sexual abuse examination, per jurisdiction protocol; however, it should be clear that there may be a need for direct intervention by the SANE, in concert with advocacy, when an acute suspicion of child sexual abuse arises, no matter when it occurred.
5. Mental health crisis workers can offer valuable services to the patient in the aftermath of the acute assault. Those services include working with SANE staff to assure that an adequate safety plan is in place for discharge and assisting with the crisis needs of family members, as well as addressing the mental health needs of the patient. Sexual assault impacts the body, mind, and spirit of the patient, which is important to remember when providing trauma-informed, patient-centered care. SANE programs may involve mental health crisis workers at any point in the examination process, and mental health staff should be familiar with the program protocol and team members. Involving this group can also be an effective way to see if your team members are meeting their own mental health needs after a particularly difficult case. They may be willing to interact with the team on a broader basis for staff meetings and personal needs.
6. Social workers may serve dual roles to arrange for housing or transportation and fill the mental health crisis worker role in some settings. 
7. Child life specialists can be employed to prepare children for examination procedures and to provide distraction during the examination. They are also useful to occupy the patient while the SANE is talking to caregivers or other team members. 
8. The SANE program should work with the billing office to make sure patients are not billed for their medical forensic examination in violation of VAWA. The billing office also needs to be sensitive about sending any statements to patients who may not want to disclose their assault to a spouse or a parent. 
9. The medical records department is involved in maintaining and storing records or photographs. The medical records department should also be involved during the creation of policies regarding the release of records.
10. The department responsible for assessing risk management should review all policies and procedures that involve patient consent and release of information.