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Presented by Project SAFE A local collaboration between VIBS Family Violence and Rape Crisis Center And United Cerebral Palsy Association of Greater Suffolk.

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Presentation on theme: "Presented by Project SAFE A local collaboration between VIBS Family Violence and Rape Crisis Center And United Cerebral Palsy Association of Greater Suffolk."— Presentation transcript:

1 Presented by Project SAFE A local collaboration between VIBS Family Violence and Rape Crisis Center And United Cerebral Palsy Association of Greater Suffolk Inc.

2 OVERALL OBJECTIVES  Staff will gain a better understanding of rape and sexual assault  Staff will be able to differentiate between rape and sexual assault  Acquire a vocabulary and comfort level incorporating sensitive and appropriate terminology  Staff will gain an understanding of the intersection of rape / sexual assault and disabilities

3 OVERALL OBJECTIVES  Staff will gain an understanding of the unique dynamics of rape / sexual assault against survivors with disabilities  Staff will learn how to respond more effectively in working with a survivor with a disability  Staff will learn what resources are essential in working effectively with a survivor with a disability

4 GROUND RULES  Use respectful language and tone  Be respectful of everyone’s different experiences  Create a safe place to:  Ask questions  Make mistakes  Learn from each other

5 RAPE AND SEXUAL ASSAULT “101”

6 STATISTICS ON RAPE / SEXUAL ASSAULT  Every two minutes, another American is sexually assaulted.  One estimate reports that 1 in 6 women in the United States has been the victim of an attempted or completed rape and 1 in 10 men has been the victim of sexual assault.  80% of rape survivors are under the age of 30, 54% are under the age of 17 Stats complied by RAINN from US Justice Department Studies,

7 STATISTICS ON RAPE / SEXUAL ASSAULT  Over 62% of rape / sexual assault survivors know their attacker  10% of rape survivors are male  30% of rape / sexual assaults are reported  Of every 20 rapes, only one will result in the rapist spending a day in prison Stats complied by RAINN from US Justice Department Studies,

8 MYTHS ABOUT RAPE / SEXUAL ASSAULT  Myth: Only certain types of women get raped. Fact: Any woman can be raped. Age, social class, and/or ethnic group have no bearing on the person a rapist chooses to attack.  Myth: Men rape women because they are sexually aroused or have been sexually deprived. Fact: Rape is about power and control and not about sexual gratification.

9 MYTHS ABOUT RAPE / SEXUAL ASSAULT  Myth: Rapes are committed by strangers at night in dark alleys or parks. Fact: Most rapes are committed by someone known to the victim and at any time of the day or night.  Myth: Men of certain races and backgrounds are more likely to sexually assault women. Fact: Men who commit sexual assault come from every economic, ethnic, racial, age and social group.

10 MYTHS ABOUT RAPE / SEXUAL ASSAULT  Myth: Men can never be raped. Fact: Men can be raped. In 2003, 1 in every ten rape victims were male  Myth: Sexual assault usually occurs between strangers. Fact: By some estimates, over 70% of rape victims know their attackers. The rapist may be a relative, friend, co-worker, date or other acquaintance.

11 DEFINITION OF RAPE Unwanted (without consent) or forced sexual intercourse to include some type of penetration, however slight. This would include vaginal penetration or anal penetration.

12 DEFINITION OF SEXUAL ASSAULT Sexual assault is an umbrella term used to encompass a range of offensive behavior that may or may not be considered criminal under New York State Law. It includes sexual harassment, sodomy, incest, and sexual abuse.

13 General:  Forcing sex or sexual acts  Forced video taping of sex acts  Not using contraceptives  Knowingly transmitting STI’s  Forcing the viewing of or participation in pornography, etc. TACTICS OF SEXUAL ABUSE

14 DEFINITIONS OF KEY TERMS  Sexual Intercourse: is “any penetration however slight”  Oral Sex: contact between the mouth and penis, anus, vulva, or vagina.  Anal Sex: contact between the penis and anus.  Sodomy: Sexual intercourse involving anal or oral copulation.  Sexual Abuse: Subjecting another person to sexual contact without consent and / or by force.

15 DEFINITIONS OF KEY TERMS  Sexual Contact: touching of the sexual or other intimate parts of a person for the purpose of sexual gratification whether directly or through clothing.  Incest: Sexual activity between close relatives that is illegal in the jurisdiction where it takes place and / or is socially taboo. Often used to define sexual abuse of a child by an adult family member.

16 DEFINITIONS OF KEY TERMS Sexual harassment: unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature when:  Such conduct is made a term of employment or schooling  Response to the conduct is used as a basis for employment or school decisions  Conduct interferes with work or school performance or creates an intimidating, hostile or offensive work or school environment.

17 SENSITIVITY IN TALKING WITH SURVIVORS  Service providers should feel comfortable in using non- slang terminology, but -  Let the survivor guide you in what feels most comfortable for them in communicating and understanding  Straightforward terminology may be re-traumatizing for the survivor  Don’t blame the survivor  Be non-judgmental  Provide legal information, but don’t impose an agenda

18 RAPE AND SEXUAL ASSAULT CAN OCCUR BETWEEN PEOPLE WHO ARE:  Married  Divorced  Have a child in common  Cohabiting  Dating or formerly dating  Family member  Primary caregiver and an individual with a disability  Stranger / Acquaintance  Friends and or neighbors Rape and Sexual Assault can occur between any two people regardless of relation.

19 COMMON EMOTIONAL REACTIONS AFTER A RAPE OF SEXUAL ASSAULT Visibly upset Crying / Sobbing Mood swings Restlessness Tenseness Anger Anxiety Masked feelings Flat affect Numbness Fear Humiliation Embarrassment Self-blame Revenge Retaliation Irritation Depression

20 COMMON PHYSICAL REACTIONS AFTER A RAPE OR SEXUAL ASSAULT  Physical Trauma.  Tension headaches, fatigue, sleep pattern disturbances.  Stomach pain, eating pattern changes.  Vaginal discharge, chronic vaginal infections  STI’s, pregnancy.

21 OTHER COMMON REACTIONS TO A RAPE OR SEXUAL ASSAULT  Guilt and Shame  Negative Beliefs about Self, Others and the World  Relationship Difficulties  May experience chronic nightmares and flashbacks.

22 POSSIBLE LONG TERM EFFECTS FOR SURVIVORS Physical lifestyle: Can endure additional / long term health problems Psychological lifestyle: nightmares, intrusive imagery and flashbacks, phobic behaviors, loss of self-esteem. Social lifestyle: changing phone number, moving residences, upset of normal routine, either turn to for support or avoid family.

23 COMMON BARRIERS TO DISCLOSING RAPE / SEXUAL ASSAULT According to the National Coalition on Domestic and Sexual Violence:  80% Embarrassed about what happened  61% Felt partly responsible  54% Did not realize they had been raped  46% Did not feel the police would be able to make an arrest

24 COMMON BARRIERS TO DISCLOSING RAPE / SEXUAL ASSAULT  45% Too upset  43% Afraid the attacker would get angry and rape them again  43% Afraid the police would not believe them  40% Afraid they would have to testify in court  36% Were too young at the time

25 COMMON COPING STRATEGIES AFTER A RAPE OR SEXUAL ASSAULT  Attempts to block memories or forget  Refuses to talk about the incident  Uses defense mechanism of denial  May self-medicate (Drugs, alcohol)  May self-injure

26 INTERSECTION OF RAPE / SEXUAL ASSAULT AND DISABILITIES

27 STATISTICS ON RAPE / SEXUAL ASSAULT ON INDIVIDUALS WITH DISABILITIES  The risk of being physically or sexually assaulted for adults with developmental disabilities is likely 4 to 10 times as high as it is for other adults (Accessing Safety Initiative Website, Sobsey 1994)  In one study, the rate of sexual abuse among people with developmental disabilities was found to be at more than 70% (Accessing Safety Initiative Website, Sobsey and Doe 1994?)

28 STATISTICS ON RAPE / SEXUAL ASSAULT ON INDIVIDUALS WITH DISABILITIES 97% to 99% of abusers are known and trusted by survivors who have an intellectual disability  32% were family members or acquaintances.  44% had a relationship with the survivor specifically related to the person’s disability (i.e. residential care staff, transportation provider, personal care attendant) (Accessing Safety Initiative Website: Baladerian, N. Sexual Abuse of People with Developmental Disabilities, Sexuality and Disability 1991)

29 STATISTICS ON RAPE / SEXUAL ASSAULT ON INDIVIDUALS WITH DISABILITIES  Over 50% of abuse is generally perpetrated by someone who is known to the victim – a family member, spouse or caregiver. Accordingly, 49% of sexual abuse perpetrators access their victims through their work in a disability service (Sobsey, 1994).  Persons with disabilities who are survivors of rape and sexual assault knew their attacker in 90% of these assaults (Valenti-Hein and Schwartz 1995as reported in A Call to Action: Ending Crimes of Violence Against Children and Adults with Disabilities. A report to the nation 2003.)

30 MYTHS ABOUT THE INTERSECTION OF RAPE/SEXUAL ASSAULT AND DISABILITIES Myth: People with disabilities are asexual, do not have sexual feelings, do not have sexual relationships and are not capable of understanding (or determining) their own sexuality. Fact: People with disabilities are sexual beings with the same needs, desires, and dreams as anyone living with out a disability. (Stop the Violence, Break the Silence: A training guide, By: Disability Services ASAP (A Safety Awareness Program) of SafePlace, Austin, Texas)

31 MYTHS ABOUT THE INTERSECTION OF RAPE/SEXUAL ASSAULT AND DISABILITIES Myth: People with disabilities are oversexed or promiscuous and need to be punished for acting on sexual needs or urges. Fact: People with disabilities are no more promiscuous than people without disabilities.

32 MYTHS ABOUT THE INTERSECTION OF RAPE/SEXUAL ASSAULT AND DISABILITIES Myth: Most of the abuse and violence perpetrated against people with disabilities is done by strangers. Fact: Of all reported sexual assaults, 91% of the perpetrators are known to the victim (Sobsey, 1988) (Stop the Violence, Break the Silence: A training guide, By: Disability Services ASAP (A Safety Awareness Program) of SafePlace, Austin, Texas)

33 MYTHS ABOUT THE INTERSECTION OF RAPE/SEXUAL ASSAULT AND DISABILITIES Myth: People with cognitive disabilities are not affected by sexual abuse. Fact: ANYONE subjected to a rape / sexual assault is affected regardless of disability or not.

34 MYTHS ABOUT THE INTERSECTION OF RAPE / SEXUAL ASSAULT AND DISABILITIES Myth: People with disabilities are not credible witnesses and can not be believed without some extra burden of evidence or excessive questions and testing of competence (disability equals non-credibility). Fact: People with disabilities can be very credible witnesses with the same support any other victim of a crime receives.

35 VULNERABILITY FACTORS OF PEOPLE WITH DISABILITIES TO SEXUAL VIOLENCE  Inaccurate societal views of people with disabilities.  Insufficient education about safety and domestic / sexual violence, personal rights, appropriate sexual relationships and proper responses to victimization.  Dependence on service providers, primary caretaker, family member or intimate partner for a range of living skills and personal assistance.

36 VULNERABILITY FACTORS OF PEOPLE WITH DISABILITIES TO SEXUAL VIOLENCE  Lack of education about perpetrator motives.  Lack of credibility in the eyes of the criminal justice system.  They are viewed as easy targets.

37 Against survivors with disabilities:  Threatening to leave or deny care if she doesn’t consent to sexual activity  Abusing intimate body parts; grabbing genitals while providing care  Taking advantage of lack of understanding about sex  Forcing sterilization ADDITIONAL TACTICS OF SEXUAL ABUSE

38 EFFECTS OF SEXUAL VIOLENCE SPECIFIC TO A SURVIVOR WITH DISABILITIES  Difficulties with systems collaboration  Separation from support network / loved ones  Adjustment to living with disability in cases where no disability was present prior to assault  New health challenges, exacerbation of existing medical issues

39 BARRIERS FOR SURVIVORS WITH DISABILITIES TO DISCLOSING RAPE / SEXUAL ASSAULT  Fear of losing housing, primary caregiver, and family.  People with developmental disabilities have additional concern that multiple entities become informed as part of mandated report process – they don’t just tell one person.  People who are totally dependent on caregivers may not be able to communicate about the assault, or may not realize what it is.

40 SCREENING FOR RAPE AND SEXUAL ASSAULT

41 POSSIBLE PHYSICAL SIGNS OF SEXUAL ABUSE Torn, stained clothing / bedding Difficulty walking or sitting Pregnancy STI’s Vaginal / Penile Discharge Infection Vaginal bleeding Anal bleeding Redness Irritation Unusual bathroom habits Weight gain / weight loss Change in hygiene habits Cuts, bruises, scratches Bite marks, burns

42 POSSIBLE BEHAVIORAL INDICATORS OF SEXUAL ABUSE  Extreme, irrational changes in behavior  Infantile behavior  Sexual promiscuity  Lavish and abundant gifts given for no reason  Unexplained fears of a particular person  Fear of being alone  Frequent bathing and/or washing  Change in attitude about body or sexuality

43 POSSIBLE BEHAVIORAL INDICATORS OF SEXUAL ABUSE  Uncomfortable with disrobing  Wearing layers of clothes  Appearing unkempt and neglecting personal hygiene  Aggressive and/or disruptive behavior  Shy, withdrawn, and depressive state  Suicide attempts

44 POSSIBLE BEHAVIORAL INDICATORS OF SEXUAL ABUSE  Self – mutilation  Excessive masturbation  Sleep disturbances  Continual daydreaming or vacant stares  Pulls away with slightest touch  Complaints about frequent, recurring physical problems

45 WHY SCREEN FOR RAPE / SEXUAL ASSAULT?  Rape / Sexual Assault is a public health concern with an American being sexually assaulted every two minutes  Rape / Sexual Assault has devastating effects on the survivor which may impede and interfere with her services.  Identifying Rape /Sexual Assault helps service providers and organizations to deliver services more appropriately and safely.

46  Always interview survivor individually, in private, away from partners, family members, caregivers or personal care attendants. If the third party is present to accommodate the needs of the survivor, service provider should, at the soonest possible time, get the survivor alone.  Advise survivor about program’s confidentiality policies and mandatory reporting obligations before requesting disclosures. TIPS TO KEEP IN MIND WHEN SCREENING FOR RAPE / SEXUAL ASSAULT

47  Use the language the survivor with whom you work uses when referring to his/her experiences. Be cautious when using words like “rape” in initial conversations.  Maintain eye contact and eye level  Maintain a nurturing / supportive tone  Respect boundaries  Do not ask “why” questions, as they can feel blaming.

48  Identify and use appropriate language that recognizes personal caregivers, or other specialized support personnel as potential abusers/ perpetrators/ stalkers.  Ask questions designed to elicit broad responses and give you a full picture of her/ his experiences and relationships  Be flexible – survivor may disclose after trust and relationship built, when its safe to talk, or after an incident TIPS TO KEEP IN MIND WHEN SCREENING FOR RAPE / SEXUAL ASSAULT

49 TYPES OF DISCLOSURES  Testing the waters  Tentative approach  The “Inappropriate” Question  A disguised disclosure  Vaguely  Using exact words

50 HANDLING DISCLOSURES  Talk to the survivor in a private place  Explain your professional role and confidentiality procedures  Report disclosure as required  Assess the immediate safety needs of the survivor

51 HANDLING DISCLOSURES  Immediately reduce any blame, guilt, or shame survivor may feel  Listen intently – story may get confusing.  Support survivor’s feelings  Offer safety planning as appropriate

52 CONSENT AND RAPE / SEXUAL ASSAULT

53 THE THREE C’S Basic Definitions: Competence: The scope of a person’s abilities Capacity: The mental ability to understand the nature and consequences of a decision Consent: Willful permission to have something happen or to do something

54 COMPETENCE  Is a judicial decision  Incompetence must be demonstrated by a lack of the needed functional abilities of the individual in certain areas  Having a developmental or acquired disability does not mean that the person is incompetent or incapacitated to make decisions

55 COMPETENCE  Being “presumed competent” however, does not mean that the person is competent  Law generally does not presume that incompetence in one area renders an individual incompetent in other areas

56 CAPACITY TO CONSENT  The mental ability to understand the nature and consequences of a decision  Incapacity occurs when there is a mismatch between the functional abilities of the person and the demands of the specific situation requiring a decision  Capacity to make a decision can be assessed by clinicians or, in some cases, by treatment teams

57 INFORMED CONSENT Permission for something to happen or to do something, given with full knowledge of the risks involved, probable consequences, and the alternatives.

58 PROVIDER RESPONSIBILITY Providers are expected to:  Respect the decisions and choices made by a person with the ability to do so (even when they disagree with those decisions or choices)  Ensure that protection is afforded those persons that do not have the ability to make those decisions

59 CAPACITY TO CONSENT TO SEXUAL CONTACT Exists when:  The person is an adult generally defined as 18 years or older  He/she is capable of making a decision to engage in the type of sexual contact under consideration,  He/she has full knowledge and understanding of the activity  He/she has an ability to convey this decision.

60 CAPACITY TO CONSENT TO SEXUAL CONTACT The evaluation of a person’s ability to consent should include consideration of the following:  The person’s awareness of having the choice to engage in or to abstain from the type of sexual contact under consideration  The person’s ability to make a choice as to whether or not to engage in the type of sexual contact under consideration

61 CAPACITY TO CONSENT TO SEXUAL CONTACT  The person’s awareness of the nature of the sexual activity and its risk and consequences.  The person’s understanding of what constitutes sexual expression, and the possible need for restrictions as to time, place or behavior.

62 CAPACITY TO CONSENT TO SEXUAL CONTACT  The person’s understanding of how to prevent pregnancy and diseases which are sexually transmitted  The person’s understanding that sexually assaultive behavior is prohibited and a crime, and sexually exploitative behavior is inappropriate.

63 RESTRICTIONS ON ABILITY TO CONSENT TO SEXUAL CONTACT  A parent or legal guardian of an adult with a disability cannot limit that adult’s sexual activity except where the Court has given the parent/ guardian the authority to make such decisions  The expression of sexuality can also be reasonably limited or restricted, including the time and location, in accordance with a plan necessary for the health and well being of the individual or for effective facility management. (14 NYCRR Section 633.4)

64 PRIVACY RIGHTS  All persons have the right to privacy  All persons should also have the opportunity to discuss their sexuality on a formal, informal and private basis with anyone of their choice, provided others are willing to participate.  Sexual expression and choices of partners are private and subject to the same rules of confidentiality as other matters

65 ASSESSING CAPACITY TO CONSENT TO MEDICAL TREATMENT & COUNSELING Consider four functional abilities:  Ability to express a choice  Ability to understand information relevant to the decision in question  Ability to appreciate the significance of that information for one’s own situation, and the probable consequences of treatment options  Ability to reason with relevant information so as to engage in a logical process of weighing treatment options (Grisso & Appelbaum ( 1998) Assessing competence to consent for treatment: A guide for physicians and other health professionals.)

66 LEGAL CONSENT IN NYS  Forcible compulsion  Incapacity to consent  less than 17  mentally disabled (cognitively incapable)  mentally incapacitated (intoxicated drugs /alcohol)  physically helpless  in the custody of the state department of correctional services, office of children and family services, or a health care setting  A clear expression of no

67  VIBS mandates: *Only mandate is to report suspected or known child abuse to Child Protective Services *No mandates covering persons with developmental disabilities *Professional discretion utilized regarding Adult Protective Services for people with developmental disabilities MANDATORY REPORTING REQUIREMENTS

68  UCP Mandates: *NYS Office for People with Developmental Disabilities highly regulates agency responsibilities in allegations of abuse and other incidents of harm. *People with developmental disabilities certified by OPWDD who attend programs and services certified by OPWDD which accept OPWDD funds – ALL allegations of abuse must be reported and investigated according to stringent regulations, subject to audit. MANDATORY REPORTING REQUIREMENTS

69 RESPONDING TO RAPE / SEXUAL ASSAULT

70  You do not deserve to be abused  You have the right to be in a non-violent environment  You are not responsible for the perpetrator’s behavior  Refer her to VIBS or gain additional guidance from Project SAFE THINGS TO SAY TO A SURVIVOR OF RAPE / SEXUAL ASSAULT

71 INFORMATION FOR A SERVICE PROVIDER TO TELL A SURVIVOR AFTER A RAPE / SEXUAL ASSAULT  Encourage survivor not to shower, clean up the area, or put anything mouth (no food, water, mouthwash, etc.)  Encourage survivor to obtain medical attention (SANE Center)

72 INFORMATION FOR A SERVICE PROVIDER TO TELL A SURVIVOR AFTER A RAPE / SEXUAL ASSAULT  Provide survivor with VIBS hotline number  Provide support and tell survivor the rape / sexual assault was not her fault

73 WHERE TO GO AFTER A RAPE OR SEXUAL ASSAULT? SANE (Sexual Assault Nurse Examiner) Centers  are private, undisclosed locations set up outside the hospital emergency room  have specially trained nurses who are sensitive to rape and sexual assault issues

74 WHERE TO GO AFTER A RAPE OR SEXUAL ASSAULT? SANE (Sexual Assault Nurse Examiner) Centers  have special amenities to help make the procedure as comfortable as possible for the survivor  can request that an ERC (emergency room companion) is present

75 FAQ’S ABOUT SANE  Anyone who has been raped or sexually assaulted can use a SANE Center  It is required that the survivor seeks medical attention within 96 hours from the time that the rape / assault occurred  The three SANE centers in Suffolk are at: *Peconic Bay Medical Center *Good Samaritan Hospital *Stony Brook University Medical Center

76 WHO TO CONTACT FOR ASSISTANCE  VIBS Hotline is 24 Hours 360 – 3606  Project SAFE collaboration representatives can be contacted for further assistance on the intersection of domestic violence and disability *Kathleen Cammarata (VIBS) *Ruth Reynolds (VIBS) *Clarice Murphy (VIBS) *Pat Caso (UCP) *Dana Waite-Esposito (UCP)

77 PROJECT SAFE’S MISSION VIBS Family Violence and Rape Crisis Center and UCP-Suffolk will work together to promote a safe, accessible and responsive service environment for women in Suffolk County who are survivors of domestic and sexual violence with a physical and/or developmental disability. We will accomplish this by creating sustainable changes in our organizational cultures through:

78 PROJECT SAFE’S MISSION  Fostering collaboration  Sharing resources and knowledge  Enhancing the existing service delivery system  Implementing policies and procedures that reflect best practices of professional ethics, trust, open communication, and true understanding of the challenges and needs of survivors with disabilities

79 CREDITS Project SAFE collaboration team and Organizational Workgroup utilized the following organizations training materials in creating this power point. Accessing Safety Initiative: Funded by the Office on Violence Against Women. The website address is: Building Bridges Project: This project was a collaboration between Empire Justice Center, New York State Coalition Against Domestic Violence, and Center for Disability Rights, Inc. New York State Coalition Against Sexual Assault: As an umbrella advocacy organization for rape crisis agencies throughout New York State. Pennsylvania Coalition Against Rape: “Professional Guide for Identifying Sexual Assault in Individuals with Developmental Disabilities” Safe Place, Austin, Texas: “Stop the Violence, Break the Silence: A training guide”

80 REFERENCES RAINN: Rape, Abuse and Incest National Network. The website address is: National Coalition on Domestic and Sexual Violence


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