Using Ecological Theory to Evaluate the Effectiveness of an Indigenous Community Intervention: A Study of Sexual Assault Nurse Examiner (SANE) Programs

In recent years, there has been renewed interest among community psychologists in indigenous interventions, which are programs created by local practitioners (rather than researchers) already rooted in their communities. Indigenous interventions have strong ecological validity, but their effectiveness is often unknown because so few are rigorously evaluated. The goal of this project was to use Kelly and Trickett's ecological theory as a conceptual framework for evaluating an indigenous intervention and its mediating mechanisms of effectiveness. The focal intervention was a midwestern Sexual Assault Nurse Examiner (SANE) program, which provides post-assault medical care, crisis intervention, and medical forensic exams for sexual assault survivors. Prior studies of SANE programs have suggested that these interventions may help increase sexual assault prosecution rates. In this case example, we used a mixed methods design to determine if this program contributed to increased prosecution rates, and if so, why. Based on qualitative interviews with key stakeholders, we found substantial evidence for the Principle of Interdependence such that the SANE program strengthened the interconnections between the legal and medical systems, which contributed to increased prosecution. The intervention was effective in these outcomes because it promoted Cycling of Resources throughout the systems and fostered Adaptation of new roles for legal and medical personnel. Moving beyond this specific case example, this paper also examines cross-cutting advantages and struggles of using an ecological approach in the evaluation of indigenous community interventions.