Sexual Assault of People With I/DD

Sexual Assault
of People with IDD
MEGAN WESTMORE, LMSW
SAFE DISABILITY SERVICES

My Current Project
• In year 2 of 5 year grant from Texas Council on
Developmental Disabilities (TCDD)
• Working with Austin, Eanes, and Del Valle ISD
• Providing education to transition students with developmental
disabilities (18-22)
• 25-week curriculum on healthy relationships, safer sexuality,
self-advocacy, and leadership
© 2018 SAFE DISABILITY SERVICES PROGRAM
2

3

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• Personal safety
• Healthy relationships and sexuality
• Information, technical assistance, and
training for individuals, disability service
organizations, domestic violence and
sexual assault, families, and others
Disability Services Program

Learning Objectives
• Discuss higher rate of sexual assault and unique risk
factors for people with IDD
• Identify community and systems-based sexual assault
responses
• Understand barriers to justice for survivors with IDD
• Explore policy solutions on local, state, and national
levels
5

Issue: Sexual Assault
of People with Disabilities
6

In a large-scale national study of people with disabilities:
• More than 70% said they had been victims of abuse
• 50% reported physical abuse
• Nearly 9 of 10 reported verbal or emotional abuse
• Most experienced abuse on more than 20 occasions
• About half the incidents were reported to authorities
• Only 10% of alleged abusers were arrested
(Baladerian, Coleman & Stream, 2013)
Violence and People
with Disabilities
7

Men with Disabilities
In a survey of 275 men with physical and
cognitive disabilities, nearly:
• 65% reported they had been physically abused
• 24% reported experiencing sexual abuse
during their lifetimes
(Powers, McNeff, Curry, Saxton, & Elliott, 2004)
8

9
Sexual
Assault
of People
with
Disabilities

Perpetrators
Violence experienced by people with disabilities is most
often perpetrated by someone they know and trust.
• Acquaintances
• Family members
• Intimate partners with disabilities
• People who live in the same residence
• Service delivery system staff
10

Where Abuse Occurs
Abuse can occur anywhere, but in closed settings
(institutional settings), risk for abuse is much greater:
•State Supported Living Centers (SSLCs)
•Intermediate care facilities for individuals with
intellectual disabilities (ICF-IID)
•State hospitals
•Other residential settings staffed 24/7
11
(Hughes et. al, 2012 & Thornberry & Olson, 2005)

Behavior is Communication
• Someone may not have the language or be too scared to
disclose abuse
• We all need to pay attention to possible abuse indicators, so
we can get someone the support they want
• Various physical indicators of abuse or neglect
• Behavioral indicators
• Increase in fear or distrust
• Changes in mood
• Denial
12

Time’s Up!
• 2018 National Council on Disability report shows
survivors with disabilities are not even on the radar of
most college campuses.
• People with disabilities
often not included in the
victim rights movement.
13
For people with disabilities, too!

Unique Dynamics
and Risk Factors
14

Increased Risk—Why?
• Experiences of isolation, grief, and loneliness
• Communication barriers
• Learned compliance–grooms person
• Lack of privacy/physical boundaries
• Lack of sexuality education
• Harmful social messages
• Threat of loss of independence
• Physical or medical barriers
15

Self-Determination
as a Protective Factor
16
When a person is autonomous and has greater self-
determination, they are:
• Healthier
• More independent
• More well-adjusted
• Better able to recognize and
resist abuse.
(Khemka, Hickson, & Reynolds, 2005; O’Connor &
Vallerand, 1994; Wehmeyer & Schwartz, 1998.)

Dynamics of Caregiver Abuse
What are additional barriers
to leaving if the abuser
is your caregiver?
17

Caregiver Abuse:
What is Different?
• May take longer for people with disabilities to leave
• More men with disabilities experience abuse than
men without disabilities
• Fewer resources for people with disabilities
• Can result in devastating emotional,
medical, or even lethal consequences
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Stories from Survivors
20
https://www.npr.org/2018/01/20/577064075/in-their-own-words-people-with-intellectual-
disabilities-talk-about-rape © 2018 SAFE DISABILITY SERVICES PROGRAM

Sexual Assault Response
in Travis County
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Legal Definitions
22

Legal Definition of Adult
Sexual Assault in Texas
A person intentionally or knowingly
◦ causes penetration of anus/sexual organ of another
person by any means without consent
◦ causes penetration of the mouth of another person
by the actor’s sexual organ, without consent
◦ causes the sexual organ of another person, without
consent, to contact or penetrate the mouth, anus, or
sexual organ of another person
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Aggravated Sexual Assault
Perpetrator:
◦ Causes serious bodily injury or attempt to cause death of
victim or another person
◦ Places the victim in fear that any person is in jeopardy of
death or serious bodily injury or being kidnapped
◦ Uses or exhibits a deadly weapon during offense
◦ Administers any substance capable of impairing the victim,
with the intent to commit the offense
Also if victim is < 14 years old, elderly or has a disability
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Legal Definition
Child Sexual Assault in Texas
A person intentionally or knowingly
o causes the penetration of the child’s anus/sexual organ by any means;
o causes the penetration of the child’s mouth by the sexual organ of the
actor;
o causes the sexual organ of a child to contact or penetrate the mouth,
anus, or sexual organ of another person;
o causes the anus of a child to contact the mouth, anus, or sexual organ of
another person; or
o causes the mouth of a child to contact the anus or sexual organ of
another person.
25

Texas Legal Definition: Consent
Consent cannot exist if perpetrator:
• Uses physical force or violence, or the threat of force or violence
• Knows the individual is unconscious or physically unable to
resist
• Knows the individual is unaware that the assault is occurring
• Has intentionally impaired the victim by administering any
substance
• Uses coercion
No consent if, because of “mental disease or defect,” the
individual is unable to understand the nature of sex or of
resisting it.
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Legal Consent Definition Cont’d
Perpetrator is a:
• public servant who coerces the victim to submit
• mental health or health care provider who coerces their current
or former patient
• clergy official who coerces based on status as spiritual adviser
• an employee of a facility where the victim is a resident, unless
they are married
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Statute of Limitations: Criminal
No time limit for:
• Child victim
• Adult victim who had a sexual assault kit done
and tested, and there was no match
• Probable cause that perpetrator has committed 5
or more offenses (serial rapists)
Otherwise, statute is 10 years from the crime
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Statute of Limitations: Civil
Civil Suit
• Adult victim: 5 years from the event
• Child victim: 15 years from the victim’s 18th
birthday
Workplace sexual abuse
• File with Equal Employment Opportunity
Commission within 300 days of the alleged
harassment/abuse
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Travis County Sexual Assault
Response and Resource Team (SARRT):
Community Needs Assessment
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Community Response
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Reporting to Law Enforcement
• Survivor choice, but…
• Patrol takes initial report, then to detective
• Detective usually interviews in 2 days. Why?
• Ongoing investigation and support needs
• Victim services
• Crisis and ongoing
• Helps with things like Crime Victims’
Compensation and pseudonym
32

CPS/APS reporting
• Protected populations:
• Child under age 18
• Person age 65 or older
• Individual with a disability
• Typically investigates if alleged abuser is a family member or
an individual living in the home
• HHSC investigates abuse in licensed assisted living care
facility, nursing home, adult day care, private ICF/IID, or adult
foster care
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Who Qualifies
for an APS Report?
• A disability that “grossly & chronically diminishes physical
or mental ability to live independently or provide self-
care.”
• A mental, physical, or developmental disability:
• A medical condition
• Professionally diagnosed
• Reported or observed behavior that is consistent with
such a diagnosis
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Medical Care Options
• Physical exam for injury assessment and treatment
• Prophylactic medications (pregnancy and STI)
• Evidence collection in Travis County:
 Have 120 hours from assault to collect evidence IF
reported to police
 96 hours for a non-report exam (no law enforcement)
• Free follow-up medical services at Planned Parenthood if a
SAFE client
35

Forensic Exam Process
1. Introductions
2. Comfort, quick assessment
3. Options
4. Consents, releases
5. Medications
6. Blood and urine collection
7. Medical history
8. Assault history
9. Detailed assault information
10. Clothing collection
11. Examination of body for injury and
evidence
12. Examination of genitals for injury
and evidence
13. Photos
14. Safety planning
15. Discharge, referrals, appointments
17. Follow-up calls

Non-report Exam
• Available to people 18 and older; likely not an option for
individuals with IDD
• No collection of blood, urine, or clothes
• Unique identifier to maintain confidentiality
• Evidence kept for 2 years, then destroyed
• Victims can report to law enforcement any time during the 2
year period and have evidence retrieved and tested

Outcome of Medical
Forensic Exam
CAN CONCLUDE
Presence of injuries on body
and ano-genital.
Presence of foreign DNA or
bodily fluids, AFTER processed
by the forensic laboratory.
CANNOT CONCLUDE
Consent
Degree of force
“Diagnosis” of sexual assault
“Virginity” status
Presence or absence of injuries does not mean
that something happened or did not happen
and doesn’t have anything to do with consent

Forensic Exams in Travis County
• Exams at SAFE’s Eloise House:
 Individual assigned female at
birth and has started their
period
 Individual assigned male at
birth and is at least 12 years
old
• Pediatric patients go to Dell
Children’s Hospital
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Average Hospital
Sexual Assault Exam = $3-5K
LE (REPORTED) OR DPS (NON-REPORT)
Evidence Collection Kit
Sexual Assault Nurse Examiner’s fees
Pregnancy lab
VICTIM PAYS MEDICAL
Room in emergency dept.
◦ min $250
Medications
Diagnostic Tests
Lab fees (except for pregnancy test)
Treatment of wounds/injuries (x-rays,
stitches, etc.)
Exams at Eloise House are no-cost to victims. This includes meds!
40

Sexual Assault Advocate Role
• Legally, survivors entitled to trained advocate from rape crisis center
• Practically, little to no enforcement
• Provide sexual assault victims, their family, & friends:
• Immediate crisis intervention
• Emotional support
• Information
• Advocacy
• SAFE provides for Travis County: Combination of paid staff and
volunteers
• 60 hours of training plus buddy shifts, including information about sexual
assault victims with disabilities
41

Evidence Analysis
• Laboratory analysis depends on case
• Cannot say for certain how long it will take
• Results can identify perpetrator and can
prove body/clothing contact
• CODIS - Combined DNA Index System:
Federal database for DNA identification
• Past problems:
• Austin Police Department lab was shut
down, then reopened
• Mold was found on kits
• Kit testing backlog

Possible Prosecution
© 2018 SAFE DISABILITY SERVICES PROGRAM 43
July 1, 2016-
June 30, 2017
Austin Police
Department received
1,268 calls for
assistance with sexual
assault.

Credible Witnesses
44
Studies show that people with intellectual disabilities
are better witnesses than generally expected, except in
the area of remembering dates and times.
People with intellectual disabilities can make
credible witnesses with your patience and support!
(EVAWI, 2018)© 2018 SAFE DISABILITY SERVICES PROGRAM

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https://www.youtube.com/watch?time_continue=210&v=4u7elKzywkg
Accommodations Make Cases Winnable

Civil Legal Remedies
•Civil suit for monetary damages
•Early lease termination
•Protective orders
•School accommodations
•And more!
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Support Services
• Important for ALL survivors, regardless of support needs
• Could include crisis stabilization, individual therapy, group
therapy, and more
• Shortage of clinicians with expertise in both trauma and IDD
• Housing is a huge need for individuals escaping violence;
need is even greater for individuals with disabilities
• Emergency attendant/support staff care
47

Safety Planning: Leaving
the Relationships
• Change payee on SSI/SSDI benefits
• Deposit benefit checks into separate bank account
• Plan for assistance with personal care tasks
• Gather extra medications and adaptive aids
• Make arrangements for service animals
• Have adaptive vehicle checked and keep
full of gas
48

Barriers to Justice
for People with IDD
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Individual Barriers
to Receiving Services
• Support people may help with process, or may be unsafe
• Difficulty with cognition:
o Remembering things
o Following directions/following through
o Concentrating
o Processing information quickly
• Communication barriers
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Systemic Barriers
to Receiving Services
• Physical access to all parts of buildings/offices
• Public transportation may be unavailable or unreliable—being
on time may be out of survivor’s control
• Little or no sex and self-advocacy education
• Lack of counselors trained in both IDD and trauma
• Guardianship
• Caregiver abuse not adequately addressed in the law
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Activity: Policy Solutions
52

Local Policy Issues
In your small group, spend 5 minutes
brainstorming local (city and county) policy
issues related to sexual assault of people with
disabilities.
We will then share with the group.
53

Local Policy Issues
• Funding to test sexual assault kits (prevent backlog)
• Kit storage guidelines
• Victim notification procedures
• More dedicated staff in law enforcement offices (sworn and
victim services)
• More lab staff including digital forensic analysts (video, text, etc.)
• More counselors trained in IDD and trauma
• Low levels of prosecution. Require documentation of decisions.
54

Local Policy Issues, Continued
• Increase cold case capacity through more dedicated staff (law
enforcement and district attorney)
• Specialized sexual assault prosecutor team (only 1 sexual assault
prosecutor in Travis County)
• Allow victim services presence during law enforcement interviews
• Funding for local prevention work with disability community
• Local university disability and sexual assault training
• Hotlines trained on communication with people with IDD
55

State Policy Issues
brainstorming state policy issues related to
sexual assault of people with disabilities.
We will then share with the group.
56

State Policy Issues
• Deinstitutionalization/more accountability in institutions
• Promote self-determination through alternatives to guardianship
• Emergency protections against abusive guardians
• Clarify guardian role in forensic exam consent
• Caregiver abuse statute
• Caregiver abuse protective orders
• Mandatory comprehensive training on IDD and other disabilities
for:
◦ Law enforcement (not currently required by TCOLE)
◦ Forensic Nurse (beyond what required by OAG)
◦ District attorneys
• Increase availability of forensic nurses, especially rural
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State Policy Issues
Continued
•Enhance enforcement of:
• Accommodations throughout the process
• Sexual assault advocate
• Crime victims’ rights (only enforced through civil suits)
•Appropriations bill
• Funding for rape crisis centers and backlog
•Eliminate victim costs for forensic exams
•Extend evidence collection windows
•Funding for special prosecution units
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State Policy Issues
Continued
•Extend non-report evidence storage timeline
•Sexual assault defined as penetrative. Make groping
and other sexual assault a felony (currently class C
misdemeanor)
•Eliminate sexual assault statute of limitations
•Consent definition
•Comprehensive sex education (for all)
59

National Policy Issues
brainstorming national policy issues related to
sexual assault of people with disabilities.
We will then share with group.
60

National
• Many of the items from local and state could be addressed nationally:
• Extend time limits for evidence collection
• Eliminate the statute of limitations
• Eliminate costs for victims
• Allowing victims with IDD to record testimony in advance of trial
• Funding for rape kit testing and elimination of all backlogs
• Funding for rape crisis centers: more dedicated counselors, case managers, etc.
• Evidence storage timelines for kits
• Grants to address disability and sexual assault
• College campus mandatory training on disability and sexual assault
61

Action Plan
Get back in your small group and choose one state
policy issue. Formulate an action plan for addressing
this policy need.
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Resources
SAFE
Asian Family Support Services of Austin
University of Texas Institute on Domestic Violence and Sexual Assault
Travis County Sexual Assault Response and Resource Team (SARRT)
CASA of Travis County
Texas Advocacy Project
Texas Rio Grande Legal Aid
Texas Legal Services Center
Texas Association Against Sexual Assault (legislative)
63

Questions??
64

References
Baladerian, N., Coleman, T., Stream, J., (2013). Abuse of people with disabilities: Victims and their families speak out: A report on the
2012 national survey on abuse of people with disabilities. Retrieved on 2/18/14 from http://www.disabilityandabuse.org/survey
End Violence Against Women International (EVAWI). Successfully Investigating Sexual Assault Against Victims with Disabilities.
Retrieved June 25, 2018, from http://olti.evawintl.org/
Hughes, K., et al. (2012). Prevalence and risk of violence against adults with disabilities: A systematic review and meta-analysis of
observational studies. The Lancet, 379(9826), 1621-1629. doi:10.1016/s0140-6736(11)61851-5
Khemka, I., Hickson, L. & Reynolds, G. (2005). Evaluation of a decision-making curriculum designed to empower women with mental
retardation to resist abuse. American Journal of Mental Retardation : AJMR. 110. 193-204. 10.1352/0895-
8017(2005)110<193:EOADCD>2.0.CO;2.
Marloff, S. (2018, April 20). Is Travis County doing enough for rape survivors? Austin Chronicle. Retrieved April 16, 2018, from
https://www.austinchronicle.com/news/2018-04-20/is-travis-county-doing-enough-for-rape-survivors/
O'Connor, B. P., & Vallerand, R. J. (1994). Motivation, self-determination, and person€nvironment fit as predictors of psychological
adjustment among nursing home residents. Psychology and Aging, 9(2), 189-194. http://dx.doi.org/10.1037/0882-7974.9.2.189
65

References (Continued)
People with Disability. (2007). SADA Action Strategy Project. Sexual assault in disability and aged care residential
settings. NSW regional consultations findings and recommendations. Sydney: Author.
Powers, L.E., McNeff, E., Curry, M., Saxton, M. & Elliott, D. (2004) Preliminary findings on the abuse experiences of men
with disabilities. Portland, OR: Oregon Health & Science University Center on Self-Determination.
National Public Radio. (2018, January 18). The sexual assault epidemic no one talks about [Broadcast]. Austin, Texas:
NPR.
Thornberry, C., & Olson, K. (2005). The abuse of individuals with developmental disabilities. Developmental Disabilities
Bulletin, 33(1 & 2), 1-19. Retrieved from https://files.eric.ed.gov/fulltext/EJ844468.pdf.
United States, National Council on Disability. (2018). Not on the radar: Sexual assault of college students with
disabilities (pp. 1-79). Washington, District of Columbia: National Council on Disability.
Wehmeyer, M., & Schwartz, M. (1998). The relationship between self-determination and quality of life for adults with
mental retardation. Education and Training in Mental Retardation and Developmental Disabilities, 33(1), 3-12
66

Thank You!!
Megan Westmore, LMSW
SAFE Disability Services Project Coordinator and Educator
mwestmore@safeaustin.org
512.369.5950
67
disabilityservices@safeaustin.org
SAFE 24-hour Hotline/Chatline/Text
512.267.SAFE (7233)
For Deaf/HH/Deaf-Blind community, use relay/VRS
www.safeaustin.org

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