Program for Aid to Victims of Sexual Assault CI Report – Final

What has been most instrumenta to your progress?

We found that it was especially beneficial to emphasize flexibility in our work on this grant. As the scope and realities of what was possible evolved, we found that allowing our grant activities to also evolve was important. This evolution was a direct response to the listening we were doing in northern St. Louis county. As we spoke with stakeholders from law enforcement, advocacy, medical, and prosecution, it became clear that all parties did not share the opinion that a coordinated SANE response was the best response for their communities, despite what we had understood at the time we applied for this grant. By listening and adjusting our grant activities to support the medical response stakeholders did express support for, we were able to more effectively serve the expressed priorities of the communities in northern St. Louis county. This flexibility was much better received than insisting upon a ‘one size fits all’ approach.

We found collaboration to be incredibly important for this grant. By fostering a strong connection with the Hibbing Sexual Assault Nurse Examiner program, we have created a community of forensic nurses in northeastern Minnesota who can support one another. We have been meeting collaboratively with Hibbing SANE and PAVSA SANE on a quarterly basis since 2015. Both communities have taken turns hosting meetings. The Community Innovation grant has allowed us to help Hibbing SANE cover their costs to travel to our meetings, where both programs benefit from one another’s expertise. Our joint meetings have also allowed PAVSA SANE to prepare in-depth clinical case reviews that the Hibbing SANEs participate in. This is a great continuing education opportunity that allows Hibbing SANEs to access more exposure to diverse cases and best practice techniques for charting, photography, and evidence collection. Our grant has also made it possible to extend advanced training opportunities to Hibbing SANEs including child sexual abuse, 40 hour adult SANE training, and strangulation.

Key lessons learned

In the beginning, we struggled to be flexibility and responsive to the needs and concerns we were hearing expressed in northern St. Louis county. Because PAVSA is located in Duluth, it became clear that we needed to be very careful about how we collaborated with our partners on the Range in order to respect their autonomy and perspective as the sexual violence experts in northern St. Louis county. In order to convey this respect and our support for their work, we (PAVSA) did a lot of listening and adjusting our expectations for this grant. When our partners stated emphatically that they did not want a coordinated SANE program in northern St. Louis county, we listened. We made investments to support and connect with the Hibbing SANE program while making further investments in training for emergency room nurses and physicians in other northern St. Louis county hospitals. This training will allow ER staff to conduct sexual assault exams with a higher level of technical expertise without a specific investment in a SANE program. Listening, and being open to what we were hearing, was critical in order for collaboration to occur.

Another lesson learned was that it is difficult to achieve consensus among diverse communities. When we initially applied for the CI grant, conversations that were had with some partners in northern St. Louis county indicated that SANE was a direction they wanted to go and PAVSA SANE was a great model to follow, so PAVSA seeking this grant as a way to meet that goal made sense. Once we received the grant and initiated follow-up conversations with all stakeholders, the lack of consensus about SANE as a best practice model was evident. Some partners did not want to make an investment in regional SANE program and felt that emergency room nurses and doctors were doing sexual assault exams well. There was some offense taken at the idea that Duluth should come in and tell northern St. Louis county how to do things. We worked very hard to listen, be open to criticism, and try to come to a place of consensus about how best to utilize this grant to pursue the diverse values and priorities of our partners. In this spirit, we invested in the existing Hibbing SANE program while supporting the other rural communities with shorter, four hour trainings to enhance their expertise.

Reflections on the community innovation process

Understanding that community innovation is not linear was incredibly important and helpful to keep in mind. At times it felt like we were having the same conversations over and over again, with different results every time. We struggled to reach consensus and ultimately understood that flexibility and an openness to multiple approaches might, in fact, be a better solution than the one we had anticipated. Allowing ourselves to push reset and ‘go back to the drawing board’ a few times was important. The CI process diagram helped us and our partners to feel supported in doing so.

Other key elements of Community Innovation

Flexibility was key. It’s implied through the diagram but not stated explicitly. Flexibility and openness to new information or approaches helped us to better serve our partners and neighboring communities.

Progress toward an innovation

We have made significant progress toward developing a regional network of Sexual Assault Nurse Examiners (SANEs) in northeastern Minnesota. By fostering joint training opportunities for the personnel of the two existing SANE programs (PAVSA SANE in Duluth and Hibbing SANE), we are maximizing the full potential of these opportunities for all forensic nurses in our region. Strengthening this network and collaboration helps ensure that patients who are seen by a SANE nurse in Duluth or in Hibbing will be met by a professional SANE who has access to the most up to date medical information and best practices. It also allows the lessons that each of our respective programs learns to be shared, raising awareness and exposure to diverse and challenging sexual assault cases. As more nurses opt for SANE training or express an interest in doing so, we are building professional support and access to opportunities that have historically only been available in the Twin Cities metro. We count this network as a strong success and look forward to continuing to foster this collaboration after the grant period has ended.

What it will take to reach an innovation?

What’s next?

PAVSA SANE plans to continue to meet with Hibbing SANE on a quarterly basis. We will continue to share our resources and training opportunities not only with the Hibbing SANE program, but also with emergency room RNs from Virginia, MN and Ely, MN who express interest in further training for sexual assault exams. We also anticipate hosting a regional summit in Duluth early in 2018 that will bring together experts in sexual assault to provide advanced training to SANEs in northeastern Minnesota. We anticipate a high interest in this summit and have been in communication with the Metro-based Minnesota IAFN (International Association of Forensic Nurses) chapter to collaborate and reach a statewide audience for this summit.

If you could do it all over again…

Coming into a rural community from an urban setting can be challenging, even if it seems that there is consensus about a shared goal and respective responsibilities. In northern St. Louis county, the Duluth/Range divide is not unlike the Twin Cities metro/Greater Minnesota divide. If we were to do it all over again, it would be good to have more conversation with more of the community stakeholders before applying. While we eventually came to a place of mutual understanding through the grant, having more clarity around our respective roles, responsibilities, and opportunities may have prevented some of the defensiveness and confusion that resulted. Much work has been done to improve communication and our intra-community collaboration is stronger as a result of this CI grant.

One last thought

This grant has been an evolution from beginning to end. It has been very heartening to know we have the support of staff at Bush in demonstrating flexibility and openness to change through the grant period as new information came to light. We are very appreciative of the support we have received to press on from our grant officer. Thank you for the opportunity to collaborate with our partners in northern St. Louis county. We look forward to continuing these collaborations through the extension of our grant period.