The Implementation of the Sexual Assault Forensic Examination Telehealth Center: A Program Evaluation

Abstract

Introduction Substantial disparities in the quality of post-sexual-assault (SA) care exist in the United States, particularly in rural areas. This study evaluates the implementation of the Sexual Assault Forensic Examination Telehealth Center, a program to improve SA care by increasing access to experienced sexual assault nurse examiners via telehealth, in three rural hospitals. Materials and Methods The Dynamic Sustainability Framework (DSF) guided the implementation of the intervention. Survey and implementation data were evaluated 1 year after implementation using a nonexperimental pre–post design. Outcomes include patient and nurse perceptions of telehealth, local site nurse (LSN) confidence, and hospital protocol/policy changes. Results Forty-one telehealth consultations were completed in the program's first year. An average of 34 system-level protocol changes were made per site. LSNs demonstrated statistically significant increases in confidence to provide SA care at 1 year. LSNs and telehealth sexual assault nurse examiners (expert consultants) reported that quality of SA care improved (87% and 83%, respectively). Patients highly rated the care they received (83%), reported telehealth improved care (78%), and reported feeling better after the examination (74%). Discussion Using the DSF for implementation supported a tailored approach and successful adoption and also allowed for program iteration based on lessons learned. Conclusions The Sexual Assault Forensic Examination Telehealth model resulted in improved local nurse confidence in provision of SA care, nurse perception of improvement in care quality, and high patient care experience ratings. These findings and the use of the DSF have implications for SA specialty care implementation in rural communities.

An evaluation of a rapid conversion to teleSANE in response to COVID‐19

“…TeleSANE also offers unique, unexpected benefits in the context of a global pandemic as it allows patients to continue to receive this critical care while minimizing risk of spreading the virus. Prior literature on teleSANE has described specific programs and reported on process or implementation evaluations (Meunier‐Sham et al, 2019; Miyamoto et al, 2020, 2021; Walsh et al, 2019). The current study extends the limited, existing literature by documenting successes and challenges in teleSANE implementation in a very specific context (i.e., during a pandemic).…”

“…Future research is needed across a variety of contexts to develop further our understanding of what ensures program success. Additionally, like the currently available literature on teleSANE (Meunier‐Sham et al, 2019; Miyamoto et al, 2020, 2021; Walsh et al, 2019), this evaluation did not include patients as interview participants. All insight into the patient experience was based on the perceptions of the providers.…”

“…This presents an equity issue, as some survivors in some communities have the opportunity to access this expert care, while it is not available to others. In an effort to ensure equitable access to SANE care to those who would otherwise have no opportunity, communities across the country have begun to pursue telehealth technology as a means to provide this expert care, an approach often referred to as teleSANE (Meunier‐Sham et al, 2019; Miyamoto et al, 2020, 2021; Walsh et al, 2019). For example, in Massachusetts (MA), the Massachusetts Department of Public Health (MDPH) SANE program provides an in‐person SANE response in 30 hospitals, and a teleSANE response in 10 hospitals through the Massachusetts Department of Public Health National TeleNursing Center (MDPH NTC).…”

“…Much like the initial development and widespread adoption of in‐person SANE programs (see Shaw et al, 2017), teleSANE programs are being explored, developed, and implemented in communities across the country at a faster pace than research and evaluation efforts to understand their impact. While several evaluations are currently underway as part of the 2019 OVC‐funded cohort demonstration project, the available limited literature in this area consists of descriptions (Meunier‐Sham et al, 2019; Miyamoto et al, 2020) and process or implementation evaluations (Miyamoto et al, 2021; Walsh et al, 2019) of the first two teleSANE programs. These early research and evaluation findings position teleSANE as a promising practice that may improve the provider and patient experience, though additional research is needed.…”

Sexual Violence—Another Public Health Emergency

“…However, the specialty faces a persistent shortage of professionals, limiting access to quality post-SA care. Current innovations such as the SAFE-T Center use telehealth to address care inequities in rural areas and are gaining traction in legislative as well as clinical settings across the US . Studies about what survivors need and desire in a health care response to sexual violence are needed.…”