Sexual violence is a significant health concern for Missourians. The exact number of survivors of sexual assault in Missouri is unknown. The Missouri State Highway Patrol Statistical Analysis Center reports that in 2023, there were 2,753 reports of sexual assault, with 29.9% of victims reporting being assaulted by an intimate partner or family member. Dickman et al. (2024) reported the estimated number of completed vaginal sexual assaults in Missouri between July 1, 2022, and January 1, 2024, to be 46,913, with a possible 5,825 pregnancies resulting from those assaults. The Missouri Attorney General’s Office (AG0) released an inventory of sexual assault kits that hospitals collected in the state of Missouri between April 2020 and May 2023. They found that hospitals collected 3,684 kits during that timeframe, with 35% of the evidence kits collected from survivors who chose not to report to law enforcement (AGO, 2023). This would indicate that not only do most Missourians who were sexually assaulted not report to law enforcement, but they also do not seek medical care. While the number of reported cases does not capture all the acts of sexual assault committed in Missouri, it does represent an alarming amount of violence taking place in the state. In addition to the immediate trauma experienced by survivors and victims, many report a higher prevalence of adverse health outcomes, including asthma, irritable bowel syndrome, diabetes, chronic pain, and activity limitations (Basile et al., 2022. Victims who have been assaulted by a partner, former partner, or family member are staggering. Additionally, domestic sexual assault victims are more likely to suffer PTSD and commit suicide (Taylor & Gaskin-Laniyan, 2007). Recent research published in the American Journal of Preventative Medicine calculated the average lifetime cost of rape per victim to be $122,461 (Peterson et al., 2017). Given the prevalence of the problem, adverse health outcome
s, and economic impact, sexual violence is a significant problem for Missouri. Care by a trained sexual assault nurse examiner (SANE) has been shown to increase positive patient outcomes. When SANES provide care to patients, patients are more likely to be treated with prescribed pregnancy and sexually transmitted infection prophylaxis and to receive follow-up care. Most Missouri hospitals do not have sexual assault forensic exam programs offering care to survivors 24 hours a day, seven days a week, with rural hospitals having the least number of available services. Only 20 of the 99 rural counties in Missouri reported having sexual assault services available. To help expand services to rural and underserved areas of the state, we propose an educational program that combines online didactic modules with forty hours of in-seat clinical training and ongoing education, mentorship, and support. This program will be offered in six locations in Missouri to improve access to a diverse population of nurses and prescribers. Our goal is to address the barriers preventing nurses from obtaining SANE education as well as the causes of low retention rates, thereby increasing the overall quantity and quality of care received by Missouri sexual assault survivors. By improving the availability of quality care where the victims live, more victims will seek care, thus increasing the number of reports, investigations, and prosecutions, resulting in fewer cases of sexual, domestic and intimate partner violence in our state.