Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Sexual Assault Nurse Examiner (SANE) programs have been developed to simultaneously address the health and psychological needs of sexual assault survivors as well as the need to collect good forensic evidence (U.S. Department of Justice, 2004). Case reports from local SANE programs suggest that programs with interagency collaboration (e.g., victim advocates, law enforcement, prosecutors, and other medical providers) may increase the ability to address the simultaneous goals of survivor treatment and forensic evidence collection (Selig, 2000; Smith et al., 1998). In fact, many communities have developed formal teams, Sexual Assault Response Teams (SART), to coordinate responses to sexual assault. However, some evidence suggests that conflicts between key players, such as advocates, medical providers, and law enforcement, can occur (Crandall & Helitzer, 2003; Hatmaker et al., 2002; Riger et al., 2002). Systematic assessment of the quality of collaboration between key community responders to sexual assault victims has received very limited attention in the literature. The purpose of this study is to examine SANE programs' working relationships with community agencies that provide care to sexual assault victims.

Findings are from a national, telephone survey of randomly selected SANE programs serving adult clients or adults and children (N = 231, response rate = 91%). Interviews lasted between 30 and 45 minutes each. The survey was confidential with all identifying information removed from the survey responses. Presented data are from closed-ended as well as open-ended questions, which were analyzed for themes. The majority of program coordinators (respondents) were registered nurses or nurse practitioners (84.8%).

The majority of the SANE coordinators reported that they had excellent working relationships with key community agencies, such as victim advocates, law enforcement, and medical providers. However a sizeable minority of respondents reported a less than excellent relationship with prosecutors (48.1%), hospital administration or staff (48.1%), and law enforcement (45.9%). Nearly one-third of the respondents reported having experienced conflicts related to roles and boundaries with the victim advocacy organization. Types of problems experienced included conflicts related to autonomy, control, or “turf” issues (80.0%), specifically role conflicts (44.3%), personality conflicts (8.6%), differences in objectives or values (12.9%), lack of preparedness (8.6%), adjustment to the idea of working as a team (4.3%), and others not being clear about the roles of team members (2.9%). Programs that reported never having had conflicts with the advocacy organization as well as programs that reported having problems in the past but that their conflicts had been resolved, indicated the following were important for good working relationships: good lines of communication (80.7%), establishing clear roles and boundaries in training materials and policies (67.0%), working in close collaboration with the advocacy organization in developing the SANE program (4.6%), team members' appreciating each others' work (5.5%), belonging to the same program (2.8%), and changes in personnel (2.3%).

These results suggest that teams must negotiate the rules and boundaries for working together. In addition, results suggest that future research should examine structural and personnel factors that contribute to more collaborative working relationships.