People with developmental disabilities are particularly vulnerable and in need of protection from sexual exploitation. Exploitation can be defined as one person taking advantage of another person without their consent. It also entails situations in which the accused induces the victim to engage in an activity by abusing a position of trust, power or authority to rob a person of free will. In other words, it has been said that sexual exploitation involves a breach of trust. For people with developmental disabilities, sexual exploitation may be initiated by peers, acquaintances, family members, or caregivers.
There are many explanations why people with developmental disabilities may be at increased risk of sexual exploitation.
- Dependence: Many people with developmental disabilities are acutely dependent on their caregivers for such needs as bathing, dressing, using the toilet, etc., but frequently they have little choice as to who assists them with day-to-day personal care. They are less likely to report exploitation or take steps against the exploiter due to fear of losing services they depend on. They are less likely to understand what is happening to them, in terms of the exploitative nature of the relationship, and they are less likely to question caregivers and those in positions of authority.
- Need for Acceptance: While the need to be liked or accepted can lead to sexual exploitation for everyone, it can be particularly difficult for those who are less physically or socially capable. Being lonely or isolated and having low self-esteem can increase this vulnerability.
- Lack of Communication: Difficulty communicating can increase a consumer's vulnerability to exploitation as the exploiter may know that there is less likelihood of "getting caught" as the situation may not be reported. Caregivers should always be aware of subtle, non-verbal attempts to communicate potentially exploitive relationships and situations. For example, this could be exhibited as a consumer who is suddenly fearful of one particular person or suddenly begins to hoard certain personal items.
- Power and Authority: In any care-giving relationship, there is always an element of power. Persons with developmental disabilities may not only be physically but also psychologically dependent on caregivers. The tendency to comply with instructions of "those in charge" may lead to learned compliance with authority figures. This can be particularly troublesome if instead of support and protection, the caregiver exploits the caregiver-consumer relationship to meet his or her own needs. The atmosphere of trust is undermined when attempts by the consumer to terminate the relationship are met with threats or intimidation, thus heightening the dependent relationship.
- Pattern of Victimization: There are risk factors that exist inherent in care giving settings, particularly in situations where consumers did not choose housemates or caregivers and cannot always change these if they are unhappy or uncomfortable, thus allowing situations of victimization to continue. Historically, it has been shown that a consumer who has experienced exploitation and other victimization previously is at increased vulnerability. It is important that sufficient supervision be provided so that incidents of abuse and exploitation do not occur.
- Difficulties in Personal Relationships: Persons with developmental disabilities typically need education and encouragement to develop satisfactory personal relationships. If appropriate social relationships do not exist, inappropriate relationships (i.e., with staff, peers, etc.) may be allowed to develop or continue. If difficulties exist in forming appropriate social relationships, a phenomenon known as "transference" may develop where a consumer sees the caregiver as fulfilling another role in their lives (i.e., father figure, girlfriend, etc.). It is important for providers to present instruction and opportunities for consumers to develop fulfilling personal relationships.
Providers possess unique information about current consumer skills and needs that is necessary to develop effective training programs. When participating in the interdisciplinary team, providers can assist in developing strategies to lessen the possibility of sexual exploitation after assessing the consumer's risk. Some questions assessments should answer include:
Does the individual:
- Have some concept of their own and other's privacy?
- Know what things are appropriate in various types of relationships? Does the consumer know what is appropriate behavior with people in various roles (peers, co-workers, family members, staff) or in public or private situations?
- Know how to set boundaries and have their own personal space?
- Know that no one else is allowed to touch the private parts of their body, except for specific reasons, such as a physician's examination?
- Know whom to kiss, whom to hug, and whom to greet in some other way?
- Know that having sex for money (gifts, food, jewelry, etc.) is both illegal and dangerous?
- Know how (and to whom) to report if they're asked to have sex for money? Are forced to have sex against their will? Have been or are in situations that make them feel uncomfortable?
The Role of the Service Provider
Service providers may be confronted with issues surrounding sexual exploitation. Misunderstandings about persons with developmental disabilities may lead to providers not recognizing what constitutes sexual exploitation. Staff members may believe that people with developmental disabilities are either sexually repressed (perpetual children incapable of having sex or sexual interests) or that they are sexually uncontrolled - individuals who regularly engage in aberrant sexual behaviors. Knowing how to recognize and respond to exploitation can lead to decreased risks for consumers.
Staff need to know how to react when a consumer reports being a victim of sexual exploitation. Some things to remember include the following:
- Check for any injuries and seek medical attention as needed.
- Safeguard the consumer.
- Provide care and support.
- Report the incident.
When an Individual Initiates Sexual Expression Toward Staff
Staff are often in need of guidance on what is appropriate versus inappropriate expressions of affectionate behavior. It is important to clarify what the provider's policy is concerning staff to consumer expressions of affection.
Any sexual expression between consumers and staff members (paid or voluntary) is unacceptable, even if the expression is initiated by the consumer. How to maintain appropriate caregiver-consumer boundaries should be addressed in new staff orientation, as a part of staff supervision, and in policies and procedures regarding staff expectations. In addition, providers may want to include information in this training on how staff members can deal with their own potential attraction toward a consumer. Suggested topics for staff training can be found in The Prevention of Sexual Abuse of People with Developmental Disabilities (1990) by Sobsey and Mansell.
The Arc of the United States has published the following guidelines for staff members who find themselves in a situation where a consumer makes a sexual overture to them. In a non-threatening, non-punitive and non-judgmental manner, the staff person should:
- Inform the consumer that sexual expression by staff or volunteers is not appropriate behavior.
- Document the behavior and action and report further (i.e., to the supervisor) as appropriate for the organization.
- If deemed appropriate, the consumer's interdisciplinary team will meet to address the need for further intervention (i.e., sexuality education, counseling).