Quality assurance measures

Develop quality assurance measures to ensure effective coordinated response during the exam process. Involved agencies should have mechanisms to ensure that the quality of discipline-specific response and coordinated response is optimal. Some tools to ensure consistent high-quality response by involved professionals include training, ongoing education, supervision, periodic performance evaluations, and peer reviews (e.g., medical forensic reports). Also useful in facilitating improvements to immediate response are feedback from victims and involved professionals and collection and analysis of data from the exam process (as discussed below). 
 
Obtain feedback on victim impact, the exam process, and criminal justice outcomes.  All involved responders can benefit from victims’ feedback about whether they felt response to the crime was adequate and if anything could have been done to improve response or better address their needs. It can be useful to talk with victims about their experiences during the exam process and explore how the process might be changed to better minimize trauma. Victim feedback can be obtained in several ways: by requesting completion of an evaluation form (not immediately after the exam), conducting a followup phone survey, and inviting participation in focus group discussions. Ask victims prior to medical discharge if they will allow such subsequent contacts and the best method of contacting them. Advocates can help design a victim feedback system that is sensitive, does not harm victims, and has mechanisms to quickly link victims with appropriate victim services if needed. Families and friends of victims may also be able to provide useful feedback. 
 
Obtaining feedback from and facilitating dialogue among first responders on the exam process and criminal justice outcomes is also critical. Some of this information could be routinely solicited and discussed at SART meetings and jurisdictional sexual assault coordinating council meetings (to assess what works and what needs improvement). Also, periodic evaluation of the exam process by examiners, medical supervisors/examiner program directors, advocates, law enforcement representatives, and prosecutors can help ensure that victims’ needs are addressed, problems are resolved, cutting-edge practices and technologies are utilized as much as possible, and training needs are identified. In terms of getting feedback on how the exam process impacts criminal justice outcomes, examiners can benefit from access to crime lab reports on evidence collected and feedback from crime lab personnel about improving their evidence collection techniques. Prosecutors can provide examiners and law enforcement representatives with information about the usefulness of evidence collected in case prosecution. Advocates can encourage discussion on how the exam process can affect victims’ interest in and willingness to be involved in the criminal justice system. Law enforcement representatives and other first responders can discuss with examiners and crime lab personnel optimal methods to preserve evidence from victims prior to their arrival at the exam site. These are but a few examples of how first responders could use feedback on criminal justice outcomes to improve the exam process.
 
Consider collecting and analyzing data from the exam process to better understand the nature of assaults in the community and evaluate effectiveness of responses.  (Information that identifies victims should not be included in collected data. Attention must be given to protecting victims’ identity in communities where residents tend to know one another or word of a crime travels quickly). Over time, such data may help to: [1] 
  • Track the participation of involved responders, agencies, and facilities; 
  • Evaluate the strengths and weaknesses of agency and coordinated responses;
  • Assess the effectiveness of response in different types of cases (e.g., stranger assaults versus nonstranger assaults);
  • Improve the quality of the examination;
  • Evaluate the impact of the collected evidence on criminal justice outcomes; and
  • Track and evaluate victim service outcomes.
A national SANE–SART database has been developed to allow data collection from nurse examiner programs around the country. All victim information provided is anonymous. See http://www.sane-sart.com for more details. 
 
Some jurisdictions have developed centralized databases to collect and analyze information across disciplines. However, such a venture requires significant resources, coordination, and thought regarding how to maintain victims’ confidentiality. Coordination can be particularly challenging in communities where cross-jurisdictional issues arise frequently (e.g., in tribal lands). A centralized database may be more easily accomplished if it is built into multidisciplinary coordination planning. For example, involved agencies can together determine how to utilize existing resources, seek new funding, maintain victims’ privacy, and systematically obtain data.
 
[1] Bulleted section partially adapted from the County of San Diego Sexual Assault Response Team Systems Review Committee Report: Five-Year Review, 2000, San Diego County, California. 


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