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Recognizing Possible Abuse in People With Intellectual and Developmental Disabilities. Dr. James Clay Oregon Rehabilitation Association. Overview. Definition of Intellectual Disability Definition of Developmental Disabilities Discussion of Mental Illness OAR’s pertaining to Abuse in Oregon
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RecognizingPossible Abuse in People With Intellectual and Developmental Disabilities Dr. James Clay Oregon Rehabilitation Association
Overview • Definition of Intellectual Disability • Definition of Developmental Disabilities • Discussion of Mental Illness • OAR’s pertaining to Abuse in Oregon • Special considerations for recognizing possible abuse in this population of citizens • Miscellaneous • Conclusion
Executive Function • Reasoning • Logic • Planning • Language Expression • Complexity • Memory Storage • Sequenced, consistent report of abuse would be difficult
Mild • Often appears “Normal” through early interview • With probing questions there may be confusion and contradiction • Executive Function is “loose” • May resent staff, family and the system for limitations and supervision requirements • Work is common • Little, if any trouble getting by in the world • EASILY INFLUENCED BY PEERS (Those that spend time with criminal thinkers begin to think in a criminal fashion) • Abstractions are very difficult: • How are a banana and an apple alike? • How are a giraffe and a lion alike? • How are right and wrong alike? • Were you hurt or just playing? • Substance abuse is less common than in a non-disabled population
Moderate • Usually more apparent disability • May begin to have language problems (dyspososdy) • Executive Function is more impaired • Some difficulty communicating needs • Vulnerable to Peers (Not just influenced; Easily Exploited in a financial or sexual fashion) • Supported work is common • Very little, if any, use of illicit substances
Severe/Profound • May be no communication • Executive Function is deeply impaired • Self-harm may occur • Supports at employment and living settings may be 2 staff to 1 • Fundamentally vulnerable to abuse and neglect • No use of substances
Schizophrenia • Hallucinations • Can occur in any sensorium • Experiencing things no one else does • Persistent • During times of full wakefulness • Delusions • Beliefs that are probably not, or cannot be true
Abuse among those with ID/DD • Several small scale studies have been conducted and suggest: • According to research, more than 90% of people with developmental disabilities will experience some form of sexual abuse at some time in their lives. 49% will experience 10 or more abusive incidents. • 40% of women with disabilities have been assaulted or raped • 54% of boys who are deaf have been sexually abused • 50% of girls who are deaf have been sexually abused • 68% of psychiatric outpatients have been physically or sexually abused • 81% of psychiatric inpatients have been physically or sexually abused • 56% of those who were admitted to a hospital-based unit for people with intellectual disabilities received anti-psychotic drugs without a diagnosis of psychosis or related disorder • 41% of nurses and nurses aids in intermediate care facilities who were interviewed admitted to engaging in physical abuse of the people they care for
ABuse • Daniel D. Sorensen, Chair of the Victims of Crime Committee, Criminal Justice Task Force for People with Developmental Disabilities estimates that less than 4.5% of crimes against people with disabilities in California are reported compared to the 44% of the general public who experience crimes. • The Seattle Rape Relief Project program for victims of sexual assault with developmental disabilities conclude that there is underreporting of sexual assaults of victims with developmental disabilities that exceed underreporting with other populations. • Several studies suggest 80-85% of criminal abuse of residents of institutions never reach the proper authorities. The studies have found that 40% of those criminally abused and 40% of non-abusing staff of care facilities studied are reluctant to come forward with criminal abuse issues for fear of reprisals or retribution from administrators.
Definition of ABUSEChapter 430 • Definitions • As used in OAR 407-045-0250 to 407-045-0370, the following definitions apply: • (1) “Abuse of an adult with developmental disabilities” means: • (a) “Abandonment” including desertion or willful forsaking of an adult or the withdrawal or neglect of duties and obligations owed an adult by a caregiver or other person. • (b) Death of an adult caused by other than accidental or natural means or occurring in unusual circumstances. • (c) “Financial exploitation” • (B) Alarming an adult by conveying a threat to wrongfully take or appropriate money or property of the adult if the adult would reasonably believe that the threat conveyed would be carried out. • (C) Failing to use the income or assets of an adult effectively for the support and maintenance of the adult.
Definition of ABUSEChapter 430 • Definitions • (d) “Involuntary seclusion” means the involuntary seclusion of an adult for the convenience of a caregiver or to discipline the adult. Restriction may be permitted on an emergency or short term basis when an adult’s presence would pose a risk to health or safety to the adult or others. • (e) “Neglect” including: • (A) Active or passive failure to provide the care, supervision or services necessary to maintain the physical and mental health of an adult that may result in physical harm or significant emotional harm to an adult. • (B) Failure of a caregiver to make a reasonable effort to protect an adult from abuse. • (C) Withholding of services necessary to maintain the health and well-being of an adult which leads to physical harm of an adult. • (f) “Physical abuse” means: • (A) Any physical injury by other than accidental means or that appears to be at variance with the explanation given for the injury. • (B) Willful infliction of physical pain or injury. • (C) Physical abuse is presumed to cause physical injury, including pain, to adults otherwise incapable of expressing pain.
Definition of AbuseChapter 403 • (A) An act that constitutes a crime under ORS 163.375 • (B) Sexual contact with a non consenting adult or with an adult considered incapable of consenting to a sexual act • (C) Sexual harassment, sexual exploitation or inappropriate exposure to sexually explicit material or language including requests for sexual favors. Sexual harassment or exploitation includes but is not limited to any sexual contact or failure to discourage sexual contact between an employee of a community facility or community program, provider or other caregiver and an adult. For situations other than those involving an employee, provider or other caregiver and an adult, sexual harassment or exploitation means unwelcome physical sexual contact and other physical conduct directed toward an adult. • (D) Any sexual contact between an employee of a facility or paid caregiver and an adult served by the facility or caregiver. Sexual abuse does not mean consensual sexual contact between an adult and a paid caregiver who is the spouse or partner of the adult. • (E) Any sexual contact that is achieved through force, trickery, threat or coercion.
Abuser ProfileBalderian, N (1991). "Sexual abuse of people with developmental disabilities". Sexuality and Disability9 (4): 323–335. • The sexual abuse offender is most likely to be known and trusted by the developmentally disabled victim. According to Sobsey and Doe's 1991 analysis of 162 reports of sexual abuse against people with disabilities, the largest percentage of offenders (28%) were service providers (direct care staff members, personal care attendants, psychiatrists). In addition, 19% of sexual offenders were natural or step-family members, 15.2% were acquaintances (neighbors, family friends), 9.8% were informal paid service providers (baby-sitters), and 3.8% were dates. Further, 81.7% of the victims were women, and 90.8% of the offenders were men.
Abuser ProfileSobsey, D.; Doe, T (1991). "Patterns of sexual abuse and assault. Sexuality and Disability". Sexuality anD Disability9 (3): 243–259. • Sexual abuse is common among people with disabilities because the person being abused may not realize that sexual abuse can harm them and some individuals with disabilities may not be able to tell anyone that they were sexually abused. Typically, people with disabilities learn not to question caregivers or others in authority. It is the authority figures that are often committing the abuse. Research suggests that 97% to 99% of abusers are known and trusted by the victim who has the developmental disability
Recognizing abuse • Individual • May be silent, guarded and only speak if staff are present • Report may be inconsistent • Patterned Injuries • Excessive fear and worry about safety • Physical Intervention in a NON-EMERGENCY situation • Many trips to urgent care or the ER • Self-Harm vs. Abuse by Another • Scars • Excessive Pre-Occupation with Sexuality (usually as the submissive or victim of sexual activity) • Pre-Occupation with violence in excess of that expected for other adults • Hyper vigilance (apparent paranoia)
