The sexual abuse of young people with a disability or chronic health condition

Question 1

What societal factors increase the risk of sexual abuse in young people with a disability or chronic health condition?

Answer 1

1. Dis-empowerment
2. Feel body is “owned” by others
3. Socially isolated due to institutionalization and hospitalization
4. Cultural prejudice towards those with disability
5. Less likely to be believed
6. Reduced freedom of movement
7. Reduced self-expression
8. Reduced privacy

Question 2

What educational factors increase the risk of sexual abuse in young people with a disability or chronic health condition?

Answer 2

Lack of sexual education

Question 3

What health care factors increase the risk of sexual abuse in young people with a disability or chronic health condition?

Answer 3

Likely to tolerate abuse because they have a lost privacy and have a high degree of physical intrusion

Question 4

What disability-specific factors increase the risk of sexual abuse in young people with a disability or chronic health condition?

Answer 4

1. Cognitive impairments
2. Sensory impairments
3. Mobility impairments
4. Difficulty communicating

Question 5

What presenting complaints are concerning for sexual abuse?

Answer 5

1. STI
2. Vaginal or anal trauma
3. Unexplained UTI
4. Unexplained fear of physical or gynecological examination
5. Avoidance of specific caregivers or caregiving situations
6. Self-harming behaviors
7. Sleep disturbances
8. Encopresis
9. Sexualized behavior
10. Sexual experimentation with age-inappropriate partners
11. Sexually abusive behavior toward others
12. Running away
13. Somatic complaints with no organic cause

Question 6

What institutional policies should be in place to prevent abuse?

Answer 6

1. thorough screening and monitoring of employees and volunteers;
2. chaperoning of physical examinations and procedures;
3. supervised outings;
4. an institutional culture that promotes patient privacy; and
5. being alert to, and having procedures for reporting, symptoms/allegations of sexual abuse.

Question 7

What educational recommendations are there to prevent abuse?

Answer 7

Ensure appropriate sexual education for adolescents with disabilities

Teach assertiveness and personal rights

Teach healthy sexual self-expression

Question 8

What recommendations are there for HCP?

Answer 8

Respect privacy during physical examination

Question 9

What are the CPS recommendations?

Answer 9

1. Be aware of the risks of abuse in children and youth with a disability, chronic illness or other limiting health care need;
2. Help to prevent abuse by ensuring that their respectful and empowering behaviours are a role model for patients, parents, trainees and colleagues;
3. Provide early anticipatory guidance on sexuality, personal empowerment and abuse risks.
4. Interact with schools or other community forums to ensure/enhance sexual health education;
5. Advocate for institutional policies that prevent sexual abuse, and facilitate a quick intervention if abuse has occurred.