Sex Education is a Vehicle for Racial Justice

The Sexual Behavior Research and Practice SIG unequivocally affirms that Black Lives Matter, and calls on our fellow SIGs of Association for Behavior Analysis International® as well as the organization at large, to do the same.

We invite you to examine sex education as a vehicle for racial justice, and also to examine steps for harm reduction and transformative justice (with regard to harmful sexual and relationship behavior, as well as all harmful behavior) with your clients and communities as an ongoing antecedent intervention to minimize the need for reliance on punitive systems which can exacerbate client and community harm.

The Culture of Consent with Individuals with Intellectual and Developmental Disabilities

by Robin Moyher, Ph D, BCBA-D, LBA, George Mason University

Consent is defined as giving assent or approval (Merriam-Webster Dictionary). Often and especially in the current state of #metoo, we think of consent as giving permission or agreement between two (or more) people to engage in sexual activity. Without consent, sexual behavior becomes criminal with a perpetrator and a victim. There are a few particularly vulnerable populations where sexual violence is significantly higher. This includes women, LBGTQ, children, American Indians, prisoners, and individuals with disabilities. If you are a member of more than one of these groups, your chances of becoming a victim increases. This article will focus on individuals with Intellectual and Developmental Disabilities (IDD).

IDD impacts an individual’s communication, social behavior, cognitive, and daily living skills. It also impacts learning whether to comply or not with others’ requests (especially those in positions of authority), self-advocacy abilities, access to sexual education, and potential consequences of sexual violence. Not having a strong expressive language repertoire or poor articulation could make it difficult for an individual to say “no,” even if he or she does wish to refuse the action from an abuser. Deficits in communication also impact the victims ability to report the incident. Poor social skills and judgement are also common deficits in this population. This would include situations where someone is offering a special treat for compliance with an illegal sexual act. The individual with IDD may agree with the act in order to obtain the treat, not realizing the harm it could cause. In another scenario, the individual may be coerced to keep it a secret or a beloved person could get hurt. Due to poor judgment skills, the individual with IDD would be likely to keep the secret. Yet, in a third scenario, they may follow through with an inappropriate sexual request when threatened by the harasser, once again, due to social and poor judgment skills. Closely related to social skills and judgment is the topic of credibility and gullibility. This weakness in determining what is credible and hence falling into the trap of being gullible can have negative effects on individuals with IDD. Cognitive deficits may limit the ability to determine what is and is not appropriate for care provision and interaction. Young adults with IDD often require additional support with self-care tasks such as dressing, bathing, and toileting.

Another area of impact is that at beginning at an early age, individuals with IDD are exposed to forced compliance in the sense that there is a systematic protocol in place for redirection of noncompliance. Simple everyday classroom activities, such as following directions, completing classwork, sitting in a chair and raising one’s hand, learning to take turns, and share with peers, are either met with reinforcement and praise if done correctly, or negative consequences if done incorrectly, to teach the skill. This sets the pattern for children to want to comply with adults’ requests as they have learned good things happen when they do, regardless of whether the request is preferred or not, and continues into young adulthood. The aversive consequences experienced may be more severe for this population than in the general education population (restraints and seclusion) as well. I refer to this as a ‘culture of compliance’ and will refer back to this later in the article.

Although relevant information has always been hard to obtain, researchers have known for more than two decades that people with IDD face serious risk of being sexually assaulted or abused (Sobsey & Varnhagen, 1989). Martin et al. (2006) and Casteel, Martin, Smith, Gurka, and Kupper (2008) concluded that this trend has not changed. The risk of sexual violence lasts throughout the individual with IDD’s lifespan. Also, it is important to note that individuals with IDD are abused by strangers only 8% of the time (Martinello, 2014). Furthermore, 36.7% of the abuse occurred in settings that were encountered because the individual had a disability, such as assistance with a daily living skill or assistance with an employment task (Sobsey & Doe, 1991; Sobsey & Varnhagen, 1989). Therefore, based on these statistics, an individual with IDD who experiences sexual violence is more likely to know the person, and be in a setting and/or situation because of their disability. Frequently individuals with IDD are educated to comply with task requests, may not have had opportunities to not comply (Akbas et al., 2009), and furthermore have a history of reinforced compliance (Wacker, Parish, & Macy, 2008).

Willness, Steel, and Lee (2007) conducted a meta-analysis on the antecedents and consequences of sexual harassment and confirmed that the impact of sexual harassment on the victim is significant in job-related variables (job satisfaction, work productivity, job withdrawal) and more so in personal health variables (mental health, physical health, PTSD, and life satisfaction). In another meta-analysis of antecedent and consequences of workplace violence, Bowling and Beehr (2006) identified consequences of workplace harassment to include strains, anxiety, depression, burnout, lower self-esteem, and lower life satisfaction. Besides job and personal health variables, there is also a financial cost to sexual harassment.

Research has not addressed adequately interventions to teach sexual violence awareness to individuals with IDD. No research has been found to teach these skills in the employment setting only. Training in awareness and prevention strategies is needed for this population in order to increase personal safety at work. For my dissertation in 2016, I investigated the functional relation of a training module for teaching sexual harassment prevention to women with IDD to raise personal safety, awareness, and knowledge in the employment setting. Using multiple baseline probe, all nine female participants were able to respond appropriately to a sexual harassment lure in terms of saying no, leaving, and reporting accurately to a trusted adult. This is great news! I’m currently in the process of turning this intervention into a curriculum. One result of my analysis clearly shows the ‘culture of consent’ this population has been taught. There were two types of harassers in the scenarios presented to the participants—Other (coworker, driver) and Boss. A descriptive analysis was conducted to determine to which harasser participants were most likely to agree to the lure or not agree but also not say “no” during baseline. Of the 97 scenarios presented during baseline where the harasser was Other, participants agreed to the lure in 6% of the instances. Of the 59 scenarios presented during baseline where the harasser was a Boss, participants agreed to the lure in 25% of the instances. Of the 97 scenarios presented during baseline where the harasser was Other, participants did not agree but also did not say “no” to the lure in 69% of the instances. Of the 59 scenarios presented during baseline where the harasser was a Boss, participants did not agree but also did not say “no” to the lure 44% of the instances. In summary, participants were more likely to agree to a lure when it was presented by a Boss, and more likely not agree but also not say “no” when it was presented by Other.  During the intervention, no participants agreed to any of the lures in intervention, regardless of who the harasser was.

This forced culture of consent greatly impacts an individual with IDD ability to refuse unwanted sexual behavior, especially if the person is seen as an authority. The good news is this can be reversed! And it does not need to wait until the individual is an adult either! Teaching consent can and should be taught as early as possible. When toileting and helping with self-care (putting on a jacket, teeth brushing, etc.) the adult should always ask to enter the child’s space and ask permission to do the behavior. When in school, teachers should do the same. Teach that because you gave consent one time does not mean you gave consent for repeated future events. And that you have the right to change your mind. Role play so the student practices saying a firm no. Role play retelling an event accurately so the listener will no the student was in a dangerous place. There is a big difference in ‘he gave me flowers’ and ‘he gave me flowers, but I’ve asked him several times to stop’. Giving students the power to say no in terms of self-advocacy and self-determination is one of the greatest skills we can teach. I find that we, as behavior analysts, are the perfect professionals teach this life saving skill.

 

The Behavior Analyst’s Role in Increasing The Fourth P: A Critical Review of The Fight Against Commercial Sexual Trafficking

by Alisha Sanders, MA, BCBA

The year 2000 was pivotal in the fight against commercial sexual trafficking. The president signed the Trafficking Victims Protection Act and the U.N. established the Protocol to Prevent, Suppress, and Punish Trafficking. (The State Department, 2002; United Nations, 2002) For the first time in history, government organizations recognized the epidemic of sexual exploitation that was sweeping across the globe. They clearly established this crime as: sex trafficking in which a commercial sex act is induce by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age. (The State Department, 2018) It is imperative to discern that although trafficking lies within the realm of prostitution, it is not a willing act upon the part of the victim. Overwhelmingly, 86% of sex workers claim to have been coerced into “the life” of commercial sex industry by another person. (Kellison, et.al, 2019)

U.S. legislation primarily focused on three essential objectives; Prevention, Protection, and Prosecution. The Department of Justice made significant efforts to disseminate awareness to local law enforcement and judicial authorities across the country through annual reviews and pilot programs to improve victim identification assessments. This was a crucial component to identification of victims of trafficking (Weiner& Hala, 2008) Within the last 18 years government records indicate a substantial increase in arrests and prosecution of traffickers in the United States. The Department of Justice reported that from 2011 to 2015 the rate of referrals for prosecution of traffickers increased 82%. (2015)

Although this success has raised awareness of the scale of commercial sex trafficking within the American culture, many limitations continue to hinder further improvements in the areas of protection and prosecution. Victims have reported that many educators, nurses, doctors, and first responders have failed to recognize they are trafficked. Due to fear of physical and financial ramifications, many are unwilling to cooperate in identification of traffickers when they are identified. (Kellison, et. al, 2019: Clawson, 2009) More sobering is the percentage of victims who report they have returned to commercial sexual trafficking after emancipation from their captors. (Kellison, et al, 2019) This phenomenon has compelled victim advocates to gain a deeper understanding of environmental contingencies and barriers victims experience in order to reduce the propensity of re-entry into commercial sexual trafficking.

The University of Texas recently completed the most comprehensive study on commercial sex trafficking to date. It found poverty, unfettered access to the internet, history of abuse, level of education, access to shelter, and placement into foster care are substantial risk factors in the entrapment of vulnerable women, transgender people, and adolescents. (Kellison, et. al.,2019; Clawson, et. al., 2009)

It is evident to continue this fight a fourth objective must be established: Personalization. Society has failed to recognize the unique plight of the individuals trapped within this modern-day slavery. Countless victims endure violent physical assault, rape, forced substance abuse, isolation from family and friends, threats to family and friends, impregnation, sexually transmitted disease, and rationed provisions of food, showers, and beverages. (Kellison, et. al.,2019; Clawson, et. al., 2009) The long-term implications of these manipulation techniques are substantial. Many survivors are diagnosed with mental disorders such as PTSD, Stockholm’s Syndrome, depression, generalized anxiety and fail to thrive within the social expectations of daily life.

Grass roots efforts among religious sectors and non-profit organizations have established housing, education, substance abuse treatment centers, short term counseling services, and access to jobs. This is an essential component to reducing the barriers victims experience when applying for a job, preparing food, paying bills, finding shelter, caring for their children, seeking medical care, initiating sobriety, and removing themselves from “the life” of the sex industry. (Kellison, et.al. 2019; United Nations, 2002; Office of the Texas Attorney General, 2018; The State Department, 2018)

The one missing component of increasing Personalization within the current system is implementing long term trauma-informed care. Victims struggle to utilize socially significant functional skills in maintaining their quality of life. (Kellison, et.al. 2019) Legislators recognize this. The State of Texas recently appointed a Director of Sexual Trafficking and The United States House of Representatives passed the Put Trafficking Victims First ACT in February 2019. Both entities have established providing long term evidenced based trauma interventions for victims is vital and have proposed funding for pilot programs in this endeavor. (Office of Texas General Attorney, 2018; H.R. 507, 2019)

Behavior Analysts have a unique opportunity and responsibility to share our knowledge to reduce barriers faced by victims of commercial sexual trafficking. Acceptance and Commitment Therapy and comparable third-wave behavioral therapeutic supports have been utilized as meaningful interventions for diverse populations (Powers, et. al, 2009; Dougher, Twohig & Maddes, 2014; Leoni, Cortis, & Cavagnola, 2015). More significantly, the validity of these interventions to reduce maladaptive behaviors and barriers within trauma victims have been replicated. (Mclean, Follet, 2016; Spidel, Dargineault, Kealy, & LeComte, 2018; Orsillo, Batten, 2005; Lucian, et. al, 2014). Twenty-one years ago, Friman, Hayes, and Wilson published a paper posing the challenge to Behavior Analysts to expand our understanding of emotion to implement interventions focused on reducing socially significant behaviors associated with anxiety. (1998) We have yet to meet that challenge.

There is very little research on effective interventions for populations affected by domestic violence, sexual assault, and commercial sex trafficking. (Burrows, 2013) Social advocates are demanding more. It is critical Behavior Analysts lend our expertise to this cause. We must strive to increase the quality of life for victims of commercial sex trafficking by expanding our research of ACT and comparable third wave therapeutic behavior supports. It is time to join the fight against commercial sex trafficking.

References

Burrows, C. J. (2013). Acceptance and commitment therapy with survivors of adult sexual assault: a case study. Clinical Case Studies. https://doi.org/10.1177/1534650113479652.Google Scholar

 

Clawson, H.J., Dutch, N., Solomon., Goldblatt Grace, L. (2009). Human Trafficking Into And Within The United States: A Review of The Literature. (Report No. 0990-0379). Retrieved 5/10/2015 from https://aspe.hhs.gov/report/human-trafficking-ad-within-united-states-review-literature.

 

Dougher, M., Twohig, M.P., Maddes, G.J., (2014). Editorial: basic and translational research on stimulus-stimulus relations. Journal of Experimental Analysis of Behavior. 101, 1-9

 

Friman, P.C., Hayes, S.C., Wilson, K.G. (1998). Why behavior analysts should study emotion: the example of anxiety. Journal of Applied Behavior Analysis. 31, 137-156.

 

Kellison, B., Torres, M. I. M., Kammer-Kerwick, M., Hairston, D., Talley, M., & Busch-Armendariz, N. (2019). “To the public, nothing was wrong with me”: Life experiences of minors and youth in Texas at risk for commercial sexual exploitation. Austin, TX: Institute on Domestic Violence & Sexual Assault, The University of Texas at Austin. Retrieved 5.15.2019 from https://sites.utexas.edu/idvsa-redesign/files/2019/03/CSTT-HT-Final-Report-3.26.19.pdf.

 

Leoni, M., Cortis, S., Cavagnola, R. (2015). Third generation behavioral therapy for neurodevelopment disorders: review and trajectories. Advances in Mental Health and Intellectual Disabilities. Vol. 9, Iss. 5, 265-274.

 

Lucian, C., Valdivia-Salas, S., Ruiz, F.J., Rodriguez-Valverde, M., Barnes-Holmes, Y., Gutierrez-Martinez, O. (2014). Effects of an acceptance/diffusion intervention on experimentally induced generalized avoidance: a laboratory demonstration. Journal of Experimental Analysis of Behavior. 101, 94-111.

 

Mclean, C., Follet, V.M., (2016). Acceptance and commitment therapy as a nonpathologizing intervention approach for survivor trauma. Journal of Trauma & Dissociation. Vol. 17, 138-150.

 

Motivans, M., Snyder, H.N. (2015). Federal Prosecution of Human-Trafficking Cases, 2015. (Report No. 251390) Retrieved 5/20/2019 from https://www.bjs.gov/content/pub/pdf/fphtc15.pdf

 

Office of the Texas Attorney General (2018). The Texas Human Trafficking Prevention Task Force: 2018 Report to the Legislature and the Legislative Budget Board. (Report No. 2018) Retrieved 5/15/19 from https://www.texasattorneygeneral.gov/sites/default/files/files/divisions/criminal-justice/HumanTrafficking

 

Orsillo, S.M., Batten, S.V. (2005). Acceptance and commitment therapy in the treatment of post traumatic stress disorder. Behavior Modification. 29, 95-129.

 

Power, M.B., Zum Vorde Siv Vordig, M.B., Emmel Kamp, P.M.G. (2009). Acceptance and commitment therapy: A meta-analytical review. Psychotherapy and Psychosomatics. 78, 73-80.

 

Put Trafficking Victims First Act of 2019, H.R. 507, House of Representatives. 116d Cong., 1st Sess. (2019) Retrieved on 5/21/2019 from https://www.congress.gov/congressional-record/2019/02/07/house-section/article/H1409-1

 

Spidel, A., Dargineault, I., Kealy, D., LeComte, T. (2018). Acceptance and commitment therapy for psychosis and trauma: investigating links between trauma severity, attachment, and outcome. Behavioral and Cognitive Psychology. Vol. 47, Iss. 2, 230-243.

 

The State Department. (2018). Trafficking in Persons Report 2018. (Report No. 282798). Retrieved 5/15/2019 from

https://www.state.gov/reports/2018-trafficking-in-persons-report/

 

The State Department. (2002). Victims of Trafficking and Violence Protection Act 2000: Trafficking in Persons Report. (Report No. 10815). Retrieved 5/15/2019 from https://www.state.gov/documents/organizations/10815.pdf.

 

The State Department. (2001). Victims of Trafficking and Violence Protection Act 2000: Trafficking in Persons Report. (Report No. 4107). Retrieved 5/15/2019 from https://www.state.gov/documents/organizations/4107.pdf.

 

United Nations. (2002). Protocol to Prevent, Suppress, and Punish Trafficking in Persons Especially Women and Children. (Report No. A/55/383) Retrieved 5/15/19 from https://treaties.un.org/doc/Publication/MTSG/Volume%202011/Chapter%20XVIII-12-a.en.pdf.

Staff Training in Sex Education

An except from Sorah Stein, MA, BCBA, CSE

A concerning number of BCBA and BCaBA appear to be addressing sexuality education and sexual behavior as falling within the scope of practice for BCBA and BCaBA, as merely topographies of behavior. This paper will present the steps one can take towards additional training and expertise in this realm and suggest this is the ethical approach towards behavior analyst practice in sexual behavior.

When one wants to earn status as a Board Certified Behavior Analyst (BCBA) or Board Certified Assistant Behavior Analyst (BCaBA), there is an extensive process of coursework and clinical experience that must be completed before one can apply to take the certification exam. This process includes completing a qualifying degree and a required number of course hours (270 until 2022) covering five specific content areas as established by the Behavior Analyst Certification Board (BACB; BACB, 2018). Additionally, one must complete, under supervision (at 5% of hours) a number of clinical hours covering a range of tasks (BACB, 2012, 2017) typically done by those with board certification (1500 for BCBA, 1000 for BCaBA until 2022). Following certification, one must obtain continuing education units every certification cycle in order to maintain certification.

Within behavior analysis, many clinicians pursue additional training to establish expertise in specialty areas of practice, such as feeding, organizational behavior management, fitness coaching, ACT, and gerontology. Most of these involve attending conferences, certification programs, and boot camps, for example. However, few seem to pursue similar depth of training in human sexuality to address sexual behavior and provide sexuality education for their learners.

When one wants to become a certified sexuality educator, the process is not wholly dissimilar to that of the BCBA or BCaBA. The certifying organization is The American Association of Sexuality Educators, Counselors and Therapists (AASECT). AASECT requires 90-hours of core education (only 75 of which can be completed online), covering 17 core areas, plus 60-hours of coursework in how to provider sexuality education (only 30 can be completed online). Additionally, one must complete at least 1,000 hours of professional experience, with the constraint that these hours be completed within 2-5 years and a 10% supervision requirement. Following AASECT certification, continuing education is required as well. One could easily argue that this is a rigorous process that should produce a clinician extremely well-versed in the range of human behavior.

Attempting to address sexual behavior in learners with intellectual and developmental disabilities without extensive knowledge of hormones, human development, anatomy and physiology, normal range of sexual function and medical issues that can impact said functioning, etc. can result in a behavior analyst missing a crucial contributing factor to the topography of concern and result in an intervention that might be ineffective at best and unethical at worst.

SBRP SIG at ABAI 2019

Thank you all so much for participating at this year’s annual conference in Chicago, IL. It was so wonderful to connect with so many folks invested in this work!

Thank you so much to all of our symposia presenters and panelists, and the quality they brought to their work and to the conference this year.

On Saturday, May 25th, members of SBRP SIG kicked off the conference at poster #143 at the annual ABAI Expo.

 

2019 sig 8

On Sunday, May 26th, we presented a symposium entitled “’Problematic’ in Sexual Behavior: Operational Definitions and Interventions” which included the following presentations: “Rule 34 and Client Rights: Definitions of “Problematic” and “Pornography”” by Barb Gross, “The Right to Be a Slut—Or Not: Tacting Desire and Building Correlating Skill Sets” by Worner Leland and Janani Vaidya, “The Evolution of Technology and the Treatment of Problematic Sexual Behavior in Real World Settings” by Stephani Fauerbach, Kimberly E. Church, and Ashley Tomaka, and “and “Managing Harmful Sexual Behavior: Keeping Everyone Safe” by Duncan Prichard, Heather Penney, and Veda Richards, with discussant Sorah Stein.

2019 sig 11

2019 sig 5

On Monday, May 27th, we presented a symposium entitled “A Verbal Behavior and Relational Frame Theory Examination of Sexuality, Gender, Privilege, and Power” which included the following presentations: “Tacting Internal Experiences: Asexual and Aromantic Identities” by Janani Vaidya and Worner Leland, “When Your Lover Loves Another: Understanding Jealousy and Compersion” by Glenna S. Hunter and August Stockwell, and “Beyond Checking: A Behavioral Analysis of Privilege as a Manipulable Context” by Emily Kennison Sandoz, Karen Kate Kellum, and Evalyn Rachael Gould, with Discussant Worner Leland.

2019 sig 10

2019 sig 9

Also on Monday, we presented our panel “Risky Business Roundup: Ethics, Interventions, and Consultation in the Area of Sexuality” featuring Sorah Stein, Frank Cicero, and Nicholas Maio, and will be moderated by Janani Vaidya.

2019 sig 7

We also thank everyone who attended our SIG business meeting both in person and long-distance! We love connecting with you and are excited for what this year will bring.

sig2019 me