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Recognizing and Removing Barriers to Care

When developing a SANE program, is it important to identify barriers that may prevent survivors of sexual assault from seeking care. 

Are Services Available?

Depending on the setting of your program, some services for survivors may be limited or may not exist at all. Some SANE programs are not able to staff their facility 24/7. There are many communities that do not have community-based advocacy programs. Interpretation for non-English language speakers may be limited to a single language. As you assess what is available in your community, it is important to look at creative solutions for providing services that may not be readily available. For example, a statewide hotline could provide victim advocate services, and a language line could be used for interpretation services. A program might be able to coordinate with another program in order to make sure 24/7 services are available nearby. The goal is to have a protocol in place to ensure that all of the patient's needs are met. 

Are Services Acceptable?

The SANE program needs to work closely with different groups in the community to identify what will make community members feel safe and welcomed and to ensure that services are acceptable to all patients. For example, there is a hospital where members of the security staff wear uniforms that resemble the uniforms of immigration enforcement officers. This setting may not be acceptable for survivors who are undocumented immigrants. Rural hospitals that do not provide a private waiting area for survivors may not be acceptable because of privacy and confidentiality issues. The language used by program staff is important, too. Programs with staff who use language such as “hearing impaired,” “disabled person,” or “mental retardation,” for example, may not be acceptable to people with disabilities because this outdated language signals a lack of awareness and understanding of disability and Deaf culture.

Are Services Affordable?

Under the Violence Against Women Act (VAWA), states must certify, as a condition for certain grant funds, that the state or another governmental entity bear the “full out-of-pocket costs” for medical forensic examinations. This might include costs for medication and other aspects of medical care provided during the collection of forensic evidence, but every state is different in its approach. Some states require other sources to pay for medications and other medical expenses. SANE programs must look at the actual costs for survivors to access care, such as transportation, parking, and medications, and create strategies to make sure cost is not a barrier. For example, in Westchester County, New York, patients are transported via ambulance to SANE providers and are given taxi fare to return home. Recognizing community uniqueness requires that each community create solutions that work in their setting. Additionally, programs should be knowledgeable about victim compensation programs in their region and connect patients to advocacy services for assistance with financial needs.