Yesterdays class was great! I think everyone really had great points and asked the right questions. In class we really focused on the actual verses the socially constructed differences between people with and without disabilities. We touched on the social and financial difficulties that arise from sexually intimate relationships with in the DD community. Unfortunately, in class we were unable to really discuss the actual assessment for becoming sexually consenting as an adult with a developmental disability. As I mentioned briefly in class, each agency relies on evaluations from different psychological clinics to assess participants for psychosexual functioning. I contacted a few clinics to receive a voided copy of the evaluation but all declined to send me the forms. However, I did find an overview of the guidelines that YAI uses to evaluate it's participants.
http://www.yai.org/services/staying-healthy/4-for-better-health/2012/january/4-for-better-health.html
This evaluation is a risk assessment. No one can definitively evaluate the choices any individual will make in every situation, and there for evaluators are weighing the likelihood a participant will make a knowing choice in most situations against the risk of being sexually victimized in these same situations. Based on the above criteria an evaluator, who deems the risk low enough and the knowledge of healthy sexual behavior high enough, will distinguish the patient as sexually consenting.
My Question to each of you is: do you think these criterion are an effective indicator of a persons ability to sexually consent and why? Do you think a risk assessment is a proper way to assess sexual functioning and why?
Also for anyone who is more interested in the topic her are some amazing videos that I found while researching. I highly recommend watching them. However, if you find the video uncomfortable, you are not forced to watch it.
Thanks again for your attention and valuable insight into my topic!
12 comments:
Hey Sydney,
Thanks for great class. First of all, I would like to thank those people working with persons with developmental disabilities. First of all, it is too hard to feel what these people are feeling. However, what scares me a lot about this field is the fact that people are all different; diagnosis is different in every case. How we can establish reliability of each diagnosis? When we are measuring consent, it is very complicated to determine the IQ level of these people. It seems to me that the couple suing the facility is not that "undeveloped" as it is publicly announced.
Without any background in that area, it is hard to talk about the necessity of risk assessment. However, I am pretty sure that the role should be paid on a full history of his/her record and mental state evaluation. The information should be obtained not from particular sources but from wide range of sources, observations, psychometric testings, and any other methods.
Again, with full appreciation of the rights of these people, I believe that risk assessment is necessary because by doing evaluation we are not only determining how the person will behave towards society. We also understand the possibility of person to hurt him/her-self physically, emotionally and in any other way.
Hi Sydney! Great class and great topic! Before I get to your questions, I would like to touch upon the word usage of this risk assessments. I find it interesting that an individual with a disability is labeled as "consenting" or "non-consenting" when the decision is not really theirs at all. An individual is evaluated because they have an interest in sexual activity and yet an evaluator has a final say as to whether or not they are "consenting."
From my above comments, I think it is easy to see that I disagree greatly with these assessments. It is not fair to say that if an individual with an intellectual disability is not well educated on the various risks of sex (e.g. STDs, pregnancy, etc.) or cannot recognize exploitation, that they are "not consenting." I do not think this is fair because individuals WITHOUT disabilities have issues in these areas as well. Also, assessing these concerns is not an easy "yes" or "no" thing. There are various dimensions to understanding your risk in sexual relations as well as the possibility of exploitation or other listed concerns.
I also believe it is an inadequate way of assessing sexual functioning as this list does not delve into the acts within sexual activity at all. It only indicates the importance of keeping such things private. How does having the ability to keep your sexual activity private indicate that you are able to function sexually? Much needs to be added and discarded from these evaluations before I would call them valid or reliable.
Great class Sydney! I second Lauren's opinion. Risk assessments are super complicated and tricky and much of the time don't get the job done. This is true for a ton of the assessments use which academics have shown to be really faulty. I also think that consenting is such a coplex behavior that when you add trying to standardize something to measure someone's ability to consent that's super problematic. I think staff/mental health providers/other stake holders really need to be innovative and find ways to either supplement or recreate these techniques for assessing someone's ability to consent. Part of this is also education. Sex education and I mean nitty gritty sex education could be made accessible to everyone would be a huge step because a lot of the issues that come up with consent, I would like to believe, could be tackled with good education and I don't see why that's not a viable option in this case. It's also very pretentious of us to believe that we can asses someone's ability to consent and therefore basically decide what they can and cannot do with their love life or sex life or a combination of the two. There is a way to keep people are safe but not overstep boundaries.
Great class Sydney!!
When it comes to the topic of sexual consent for differently able individuals, the government and organizations that work with this community prefer to be safe than sorry. I agree with Monica’s suggestion of providing sex education for this population. Differently able individuals can get training/workshops in all the areas that are evaluated. Therefore, the first step should be to train them (before any evaluation). It is complicated to fully agree with what an evaluator would say about each individual case, but I believe that there should be a way to teach individuals enough so that they can fulfill their sexual needs without getting harm. I wonder whether organizations are being too cautious with these risk assessment in order to prevent individual to harm themselves or others.
Great Class on Thursday!
Since I am not very familiar with the topic, my suggestion will be to hear from a medical expert who should determine whether the medical conditions in which the patient is found do affect their sexual life or not. It should not be the responsibility of the organization to meet the patient’s sexual needs. We need to remember that sexual activity is not a need but a want. In case where the patient is deemed capable of engaging in sexual activities, it should be the responsibility of the caregiving organization to provide them with sexual lessons to their capacity so that they could have an understanding of sexuality.
I don’t agree with the risk assessment as an indicator of sexual functioning. As I mentioned above, the risk assessment contains good information that should be used as a curriculum to educate patients about sexuality as well as the norms that society holds about where sexual activities may take place.
Hi Sydney, unfortunately I wasn't able to attend your class but I found the readings and the videos to be really eye-opening. The issue of sexual content determination is a very important one, for I strongly suspect that no two DD individuals are alike and using a standardized instrument to assess a broad spectrum of mental and psychological capacities will have great limitations. As the Huffington Post article points out, what is the cut off point at which we deny the right to sex? Won't cut off points vary for different individuals who have different degrees of disability? Of course, that actual assessment establishes several criteria, but I wonder if there can be a more creative and flexible ways to gauge sex-readiness (as Monica points out).
I am also curious about the different types of partnerships. The HuffPost article cites the case of 2 DD individuals. What about a couple comprised of a DD individual and a non-DD individual? Would sex be deemed permissible? and how have the dynamics changed?
I want to target Monica's point of education. I think is important not only to educate people with disabilities on sex, but also those without disabilities. What I mean is this: our education on sex sucks as a whole-- especially in public school. When I was learning about sex, we were grouped together, shown picture of STD infected genitals and encouraged to remain abstinent instead of actually teaching us in detail the precautions that must be taken when we ARE sexually active.
It is in this same education that we must also be inclusive of people with disabilities. Like Lauren mentioned, many people even those who are unable to consent have a hard time on on STD's, STI's prevention as well. If we started a foundation of sex education inclusive of all ranges of people, with disabilities or not, the "taboo" surrounding sex with disabilities and the resulting marginalization of this community's sexual rights would at least decrease.
Kevin,
I am not sure I agree with you that sex is a want and not a need. While we do not necessarily need it for survival, we need affection, human interaction, closeness, to feel wanted for our psychological stability. I just do not think is fair to speak for disabled people in whether it is a need or a want, for some may be optional for others may be necessary. We are all human beings and I'm sure just in our class we will have different views on sex and how crucial it is in our lives. I do not think it's any different for people with disabilities.
Excellent points everyone! Marina, exactly, everyone is different, and several of you concurred Lauren, Monica, Gina, that it is difficult to develop an objective tool to assess a richly. diverse group of people.
Another improtant aspect of assessment that we discussed in the context of eco-system theory is that people change over time. Risk assessment tools are too often used at one point in time to determine life long outcomes. Thus, if you work at an agency that mandates risk assessment you can advocate to conduct dynamic assessment, at least every three months.
What about the issues of liability and funding? Kevin makes the point that the agencies are not responsible for providing the residents with sexual activity. They are held liable for their safety and welfare. Their funders are requiring that they administer these risk assessments. How could agency direct service practitioners mitigate the harms from these assessments? How else can agencies address liability? Monica suggests training and education, how could this be operationalized?
Great job everyone! It is really insightful. I am not too familiar with the mental illnesses/health but can give an opinion on the idea of consent and risk assessments. I agree with Professor Rose on the idea of recurring risk assessments rather than a one time test. Everyone is different and people change over time.
Creating a criterion on effective indicators of a persons ability to sexually consent is very controversial, as many of you stated. What is the mark of individuals being capable of consenting or not? How where these limits decided? Its all very controversial so I do not agree on limiting one's own freedom, however, it does blur the line of liability. As Monica and Danyeli stated, education and informing individuals of the dangers of unprotected sex as well as the psychological effects.
The idea of funding through the agencies is always difficult to address. Funding is broken down very strategically, as mentioned in class. One way of incorporating it is labeled sexual intercourse as "therapy" or something of that sort. Providing funding for sexual intercourse may be stigmatized by society and by the program, therefore labeling it as a form of therapy may influence the importance of this.
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