Sexual Assault Nurse Examiner (SANE) programs have tremendous potential for creating systemic changes and increasing prosecution rates for adult sexual assault crimes. To date, only one study has rigorously evaluated the legal effectiveness of SANE programs. Those findings suggested that SANEs increased prosecution rates, but these results need to be replicated and expanded upon. The proposed project adds to the current literature by determining the circumstances and contexts under which SANE programs increase prosecution, and by identifying the mediating mechanisms that explain how and why SANE programs affect case outcomes. This project is consistent with the Solicitation's goals for research on system responses to sexual assault, including medico-forensic (SANE/SART). Using a systems change theoretical perspective, the proposed project has five objectives: First,it will compare prosecution charging rates and court outcomes for cases examined in a SANE program (intervention group) to a sample of adult sexual assault cases examined using standard hospital protocols in the same community prior to the implementation of the SANE program (comparison group). The second objective is to identify victim (e.g., race, age), case (e.g., victim-offender relationship), and forensic medical evidence (e.g., injury, DNA) characteristics that predict prosecutors' charging decisions. The third objective examines the impact that SANEs have on police as a mediating pathway to increased prosecution rates. The investigational practices for police officers who have completed a SANE criminal justice training program (intervention group) will be compared to those who have not gone through training (comparison group) to determine if there have been substantive changes in police reports since the emergence of the SANE program. The fourth objective in this project is to explore how the emotional support provided to victims/survivors by the SANE program and victim advocates increased their participation during investigation and prosecution. The final objective is to create a practitioner-oriented program evaluation toolkit that can be used by other communities to assess post-SANE systems change. A series of studies are planned to address these objectives, which will include rigorous quantitative quasi-experimental designs and in-depth qualitative interviews with prosecutors, police, and victims/survivors. The results of this project will identify the 'critical ingredients' that promote successful systemic change because they are the key factors that must be implemented when SANE programs are formed. This study will examine the interrelationships between SANEs, legal professionals, victim advocates, and victims/survivors as these linkages may be critical in explaining how and why SANE programs increase prosecution rates.