4/29/2014. Impetus for project: Is staff able to differentiate between normal/typical sexual behavior and abuse among persons diagnosed with ID/DD?

Transcription

1 Overview Impetus for project: Is staff able to differentiate between normal/typical sexual behavior and abuse among persons diagnosed with ID/DD? Background addressing historical perspectives, staff training and attitudes toward sexuality Development of tool to be presented to staff Provide the survey to experts to validate Discussion of findings Childhood Victimization Foreshadows Increased Risk Reduced sense of agency in the face of authority perpetuates vulnerability to abuse Estimates of 25%-90% of all people with disabilities are abused Agencies supporting people with disabilities tend to underreport abuse Signs of Abuse Due to reduced likelihood of a formal report of abuse, clinicians should look for other signs of distress: Engaging in an increased level of sexual behavior Sleeping less Appearing agitated Estimates are that 75% of victims are female and 25% are male Historical Perspectives Shape Modern Approaches Eugenics forced sterilization in the early 1900 s Slow shifts to human rights focus in 1960 s Individuals with Disabilities Education Act Staff Training on Sexuality Staff report little training on sexuality in the ID/DD population Staff use a personal moral compass to assess and respond to incidents may be interactional gatekeepers Agencies are vague in policies meaning expectations may change from day to day or even shift to shift 1

2 Reluctance to Educate Disagreement about what topics to include Family members and staff deny access to information Perceived prohibition of sexual contact that leads to secret relationships can increase risk of exploitation Education without real world support results in poor socio-sexual knowledge and can result in sexually challenging behavior Attitudes of Staff Factors Hindering Accurate Education One-on-one instruction leads to best retention of information but is not cost effective Poor scientific validation of sexual education programming Unequal access to educational material and relationship development Little focus on sexual orientation, real world application or emotional processes Attitudes of Family Members Personal belief systems hinder value-neutral information Denial of child as a sexual being Protectionist approach to sexuality Embarrassment that labels the topic as taboo Focus on harm reduction versus emotional exploration Most agree sex education is important but feel unprepared and uncertain about supporting behaviors that conflict with a personal moral code Resistance because: Insecure in their own knowledge Assuming youth know more than they do Information may encourage experimentation Difficult reconciling human rights issues with prohibiting or denying sexuality information Repercussions of Avoiding Sex Education Reports to Authority Figures Reduced access to information due to a constricted peer group and educational setting mens rea or competency becomes a question of concern Staff may have difficulty identifying patterns of perpetration versus poor understanding of social norms Increased community inclusions depend on a social compact to respect the safety of all Sexually challenging behavior Should cognitive functioning should be taken into consideration when addressing offending behaviors? Occurs on a spectrum from threatening to coercive sexual behavior Feeds negative stereotypes of ID/DD deviance Results in reduced or restricted access to the community Unwillingness on staff s part to contact authorities Unwillingness on police s part to pursue prosecution 2

3 Research Question The research question comprising the core of this Doctoral Project is two-pronged: First, can caregivers identify sexual behaviors warranting scrutiny and accurately characterize them along dimensions that reflect sexual behaviors that are safe/consensual/normative to those that are unsafe/nonconsensual/disordered or even criminal? Secondly, can a staff person or other caregiver then respond in accordance with statutory requirements to the demonstrated behavior? An additional consideration in response to sexual behavior is whether psychoeducational steps or other clinical interventions should be implemented or whether a response should or must include making a mandated report or even taking steps to prompt law enforcement investigation. Example Survey Questions Survey Design DSM-IV TR Criteria Legal Statutes DPPC (Disabled Persons Protection Commission) Regulations, MA Assessed Coercion, Legality, Typical v Atypical Behavior, DPPC notification Rate Vignette Based on Criteria A staff person was helping everyone in the house get ready for day program. The staff knocked and opened Pat s door and found Pat rubbing their groin area while looking at an adult website with pictures of naked men and women. How would you rate this vignette based on the following criteria: Cathy stated at her ISP meeting that she wanted to go to a local bar where there are primarily homosexual women. When Sofia, a roommate of Cathy s, found out Cathy was going to go to the bar with staff, Sofia asked to go, too. When at the bar, Sofia and Cathy were seen sitting closely together in a booth. Cathy kissed Sofia on the mouth, and Sofia hugged Cathy. Typical (common) Behavior: 1 Typical (common) Aaron was walking home from the corner store and came up the street just as a staff person took the trash outside. She saw Aaron walking up the street. When a young, female child walked past Aaron, staff observed Aaron pull his sweatpants and boxers down, revealing his erect penis to the little girl. Coercion: 1 No coercion evident Legality: 1 Legal 2 - Cannot say 3 Coercion evident 3 Atypical (uncommon) 3 Illegal DPPC (Disabled Persons Protection Commission) Notification Warranted: 1 Not warranted 3 Warranted What further steps should be taken? 1 Nothing further should be done 2 Psychoeducation should be provided 3 Report should be made to the police Other? Methodology 4 Findings N=75 Vignettes vetted by several experts Pencil and paper survey Comparison of staff responses to expert responses Pearson Correlation: Age negatively correlated with the ability to correctly identify Atypical v. Typical Behavior at a statistically significant level Also statistically significant, as accuracy increased in identifying Legal behavior, there was increased accuracy in identifying coercion, typical behavior and when DPPC notification was warranted 3

4 Correlations Findings continued Final survey question: What should be done when sexual behaviors are observed? Females presented with higher mean scores than males Managers presented with higher mean scores than direct caregivers US born participants scored almost identically with non-us born participants Discussion Staff perceptions were generally aligned with expert responses to the survey questions except where noted The negative correlation with age and accurately identifying typical behavior may be related to: Generational views on what is considered deviant General perception that any sexual behavior is inappropriate Implications of Findings Discussion continued Participants generally responded in a manner indicative of making sound judgments about sexual behavior, implying an understanding of what action should be taken Literature suggests that staff are likely to report less than half of instances of abuse to authorities and even fewer when the victim and/or victimizer has a diagnosis of ID/DD Limits of Study Staff should be provided with comprehensive training on how to support challenging as well as normative sexual behavior Staff should be offered a chance to explore how personal moral compasses interface with agencybased sexuality training policies Staff should be encouraged to utilize their knowledge by following through on reporting abuse to police and/or DPPC Specific regional findings that may not apply elsewhere Replication would strengthen face and construct validity 4

5 Goals of Future Study Review vignettes with divergent expert opinions Explore where expert opinions differed to determine whether a consensus is attainable Replicate validation using experts from different cultures or regions 5