Abstract

Attitudes that paid residential caregivers have about the sexuality of clients with developmental disabilities may impact adequate and appropriate care as well as the rights of clients in residential settings. The purpose of the study was to develop two surveys to assess attitudes and intended behaviors of staff who work with individuals with developmental disabilities. A survey to measure attitudes and one to measure behavior were developed, piloted, and validated through a test-retest process and use of a previously developed survey that contained language that was dated and inconsistent. Both surveys were found to be reliable and valid, and attitudes and intended behaviors were found to be significantly correlated. The development of reliable and valid tools to assess attitudes and intended behaviors of caregivers is important for establishing appropriate training, policy, and procedures for handling sexuality-related issues with clients with developmental disabilities.

Introduction

Historically, individuals with developmental disabilities have been viewed as asexual or sexually deviant (DiGiulio, 2003). The myth of asexuality is linked to the belief that biological defects have rendered these individuals incapable of having sexual feelings as well as these individuals being seen as perpetual children based on their cognitive functioning (Bernstein, 1985; Milligan & Neufeldt, 2001). If sexual desire and behaviors are observed, they are often seen as maladaptive or bothersome. Often medications have been used to control the sexual behavior of individuals in residential facilities (whether normal or maladaptive) in lieu of appropriate education, training, and supervision (Adams, Tallon, & Alcorn, 1982).

Education and training in the area of sexuality for individuals with disabilities who live in residential settings often focus on the biological sexual functions. Individuals are usually taught skills that are necessary for personal hygiene so that staff have fewer responsibilities for assisting in these tasks (Craft & Craft, 1981). When individuals with developmental disabilities show interest in normal sexual behavior such as dating, marriage, having children, etc., it is often a surprise to caregivers and seen as inappropriate for that individual. In addition, the behavior programs for individuals receiving services may attempt to eliminate normal behaviors instead of providing education to ensure the appropriateness of the behavior (Bernstein, 1985). Some individuals are also deliberately misinformed about sexuality issues to reinforce fears and thereby control sexual expression (Servais, 2006).

In 1956, the Sexual Offenses Act resulted in service providers discouraging or preventing relationships between individuals with disabilities due to a fear of being prosecutied for letting these relationships occur (Wheeler, 2004). The 1960s saw social movements that addressed the human rights of individuals with disabilities, and this group of individuals began to self advocate in the area of sexuality. Involuntary sterilization laws in the United States were repealed in 1975, but these procedures still occur based on the decisions of family members, guardians, and service providers in order to control sexuality, sexual behavior, and prevent pregnancy in spite of available alternatives (Aunos & Feldman, 2002).

One of the problems with sheltering individuals with developmental disabilities from education about sexuality is that it increases the chance that they will be sexually abused (Alford & Aruffo, 1994). Not having information and terminology to use about sexuality leaves these individuals vulnerable, as they are less likely to understand what constitutes abuse, prevent the abuse, and/or report the abuse to the appropriate parties (Galea, Butler, Iacono, & Leighton, 2004). Research has indicated that between 25% and 83% of females with developmental disabilities have been sexually abused at some time in their life (Collier, McGhie-Richmond, Odette, & Pyne, 2006).

The individual's ability to consent to a relationship and sexual behavior complicates the issue for both the individual and those who provide support services to that individual (Parkes, 2006). While consent laws were put into place to protect these individuals from abuse, they can also restrict the human rights of that individual. Individuals who have guardians or conservators have to prove that they are capable of engaging in sexual relationships and behaviors. They may be held to higher standards of being able to prove this ability than others or, if the guardian/conservator does not approve of the individual's choice(s), they may make the process more difficult (Milligan & Neufeldt, 2001). And, having limited capacity and the inability to consent in one life area (such as managing one's finances) does not necessarily transfer to another area (Kaeser, 1992). The individual's knowledge of the topic of sexuality may be enough to be able to consent to these behaviors with the appropriate support.

While individuals with developmental disabilities are exposed to the same sexually charged media images as other members of society, these messages are often not discussed with or demystified for these individuals (Bernstein, 1985). For those who receive support services (residential, medical, vocational, psychological, etc.) the information they do get from the individuals who work with them (as well as family members) may not be consistent or may be non-existent. Service programming usually concentrates on daily living, personal care, vocational, and self-protection skills. Since many agencies are not prepared to offer sexuality programming, and staff do not feel comfortable addressing the topic(s), these issues are often referred to mental health providers (Heyman & Huckle, 1995)

Even though societal attitudes about sexuality have become more progressive for the general public, this is not always the case for individuals with disabilities. The concept of normalization "holds that retarded individuals should receive educational experiences that will enable them to lead lives as comparable as possible to those of nonretarded persons" (Mitchell, Doctor, & Butler, 1978, p. 289). Sexuality is usually not considered to fall under the principles of normalization and is typically ignored in service delivery. To ensure appropriate education and support, it is important to understand the attitudes held by the staff about the sexuality of individuals with disabilities as well as how these attitudes could potentially impact service delivery. By doing this, appropriate training and company policies can be developed to ensure that staff are prepared to provide consistent messages and education about sexuality to the individuals whom they serve. In addition the language used to describe the disabilities of these individuals is outdated and not consistent with contemporary practice (APA, 2010).

Methods

Purpose of Study

There were three main purposes for this study. The first was to create valid and reliable instruments that can be used to 1) measure the attitudes towards the sexuality of those with developmental disabilities and 2) assess intended behavior of those who work with these individuals. While other survey instruments and research studies exist, many were created pre-1990 when the attitudes about the sexuality of these individuals was different as was the language applied to these individuals (Adams, Tallon, & Alcorn, 1982; Brantlinger, 1983; Christian, Stinson, & Dotson, 2001; Coleman & Murphy, 1980; Mitchell, et al., 1978; Saunders, 1979).

The second purpose was to explore the relationship between attitudes held by paid residential caregivers and intended behavior in typical settings. Research has shown that measured intentions are a good predictor of future behavior (Cooke & French, 2008).

The final purpose of this study was to conduct research with a homogeneous professional group, paid residential caregivers, that focuses on the topic of individuals with developmental disabilities and sexuality. Much of the research in this area has been conducted outside of the United States and with participants that included individuals from a variety of professions and positions (Chivers & Mathieson, 2000; Cuskelly & Brye, 2004; Drummond, 2006; Karellou, 2003; McConkey & Ryan, 2001; Murray & Minnes, 1994; Ryan & McConkey, 2000; Yool, Langdon, & Garner, 2003).

Hypothesis

The main null hypothesis of this study is that there would be no significant relationship between the attitudes of paid residential caregivers about the sexuality of adults with developmental disabilities and their reports of intended behavior in hypothetical scenarios.

Results

Pilot Study: Instrument Development

Sexuality and the Mentally Retarded Attitude Inventory (SMRAI; Brantlinger, 1978; 1983)

The Sexuality and the Mentally Retarded Attitude Inventory (Brantlinger, 1978) is a forty item Likert scale that measures the attitudes of staff members who provided services to individuals with developmental disabilities about the sexuality of those individuals. The survey contains general questions about sexuality (e.g., "Masturbation is healthy") and items that are more specifically applied to individuals with developmental disabilities (e.g., "A retarded man and woman who have been caught having sexual intercourse would be kept apart"; Brantlinger, 1983). The answer choices given were in a 5 point Likert scale (1=Strongly agree; 2=Agree; 3=Undecided; 4=Disagree; 5=Strongly disagree). Questions were worded so a score of 1 represented the most conservative choice/attitude while a score of 5 indicate the most liberal choice/attitude.

The internal consistency reliabilities were reported to be .95 by the original creator of the instrument (Brantlinger, 1978; 1983; 1992). Murray and Minnes (1994) used a shortened version of the SMRAI (only questions specific to those with developmental disabilities) and found the reliability of this version to be .85. While the survey has been demonstrated to be reliable and valid, analysis of the SMRAI indicated that much of the item language was no longer appropriate based on current American Psychological Association (APA) standards (APA, 2010).

Developmental Disabilities Sexuality Attitudes Scale (DDSAS)

The SMRAI was used as a guide in the creation of the Developmental Disabilities Sexuality Attitudes Scale. Some statements from the SMRAI were reworded in accordance with APA (2010) standards ("adults with developmental disabilities" instead of "retarded man and woman"). Statements that were similar to one another but indicated different sexualities (heterosexual, same-sex) were included in order to be able to determine if there were differences in responses based on sexuality. This resulted in a 65 statement survey with question choices constructed as a 5-point Likert scale (1=Strongly agree; 2=Agree; 3=Undecided; 4=Disagree; 5=Strongly disagree). Items were worded to represent conservative as well as more liberal attitudes toward sexuality. However, all items were coded in the same direction such that a higher scale score represented the most conservative attitudes. A scale score was derived by dividing the computing the mean score of all non-missing items.

The pilot study to determine the reliability and validity of the DDSAS was approved by the Institutional Review Board. Pilot study participants (n=67) included doctoral students and faculty from an online university. Participants completed both the SMRAI (Brantlinger, 1978; 1983) and the DDSAS. Eighteen participated in a retest five days after completing the initial assessment. All surveys were anonymous. Basic demographic information (age, gender, education level, marital status, etc.) were collected; however, no information that could be used to identify the participant (name, social security number, student ID, etc.) was collected.

Results of the pilot study suggested that the DDSAS was reliable and valid. Internal consistency reliability, as measured by Cronbach's alpha, was .95 for the DDSAS (it was .92 for the SMRAI); these values indicate high internal consistency among items. Pearson correlation was calculated to assess the relationship between scores on the SMRAI and DDSAS (n=52) in order to assess concurrent validity. The correlation was statistically significant, r(52)=.88, p<.05, which suggests that the SMRAI and DDSAS are concurrently valid (i.e., they are measuring the same construct).

Test-retest reliability analysis was done on the surveys taken by the 18 pilot study participants who chose to participate. Pearson r calculations were statistically significant at the .05 level (2 tailed). These correlations indicate that the DDSAS is stable over time. Statistically significant correlations between the DDSAS (test) and SMRAI (retest) were also noted and thus demonstrate strong test-retest reliability (.81 to .93).

Developmental Disabilities Sexuality Situations Scale (DDSSS; Jorissen, 2008)

The purpose of the DDSSS is to measure predicted behavior in four hypothetical scenarios. These scenarios consist of possible incidents related to sexuality and/or sexual behavior of adults with developmental disabilities that may be encountered. One example scenario is as follows:

When you bring a laundry basket full of laundry to a client's bedroom at 4pm you hear what you believe to be permission to enter. When you enter the bedroom you find the client masturbating. The client is a 24 year old female who has been diagnosed with moderate mental retardation. She has difficulty understanding directions as her verbal communication is not completely developed. The company you work for does not have any policy about this type of situation. The client's risk management plan does not address anything about sexuality. You know that the client's family is very religious. What is the likelihood you would take the following actions?

A. Inform the client that the behavior needs to be stopped immediately?
B. Ask the client to stop the behavior and speak to the client later about the behavior
C. Leave the room without saying anything and leave a note so that the behavior can be addressed by their psychologist
D. Excuse yourself, leave, and speak to them later about the behavior
E. Excuse yourself, leave, and sit down with the client later and reinforce the behavior as appropriate in the environment they were doing it in.

Participants are asked to rate their likely behavior in the given situation behavior on a scale of 1 to 5 (1=Very likely; 5=Very unlikely). Ratings of 1 (Very likely) for choices A, B, C are considered the most conservative while ratings of 1 are considered the most liberal for choices D and E. Items A, B, and C were reverse scored so that a score of 1 is the most liberal on all items while a score of 5 is the most conservative. Items were summed to derive a total score. A higher scored indicates a more conservative and less tolerant approach to client sexuality.

Cronbach's alpha for each of the scenarios are as follows: Scenario A=.53; Scenario B=.74; Scenario C=.78; Scenario D=.89; and Combined=.81.

Main Study

Employees of a for-profit residential service company in an upper Midwestern U.S. state comprised the participant pool for the main study. The company employs approximately 57 employees. The company serves clients that have a primary diagnosis of developmental disability, and the majority of clients have some type of secondary (e.g., psychiatric) diagnosis. Employees are required to have some experience working with individuals with developmental disabilities, and managers are required to have at least a bachelor's degree. Twenty-two staff members (17 direct care and 5 managers) were administered the DDSAS and the DDSSS. Demographic information was collected for this group of participants as well.

Null Hypothesis: There will be no significant relationship between the attitudes of paid residential caregivers about the sexuality of adults with developmental disabilities, as measured by the DDSAS, and their predicted reactions to hypothetical scenarios as measured by the DDSSS. The Pearson correlation analysis suggested that total scores on the DDSAS and DDSSS were highly correlated, r(22)=.68, p<.01. Correlations between DDSAS scores and DDSSS scenario 2 scores were statistically significant, r(22)=.49, p<.05,) as was the correlation between the DDSAS and scenario 3 scores (r(22)=.72, p<.01). These correlations support an expected positive relationship between attitudes and intended behavior. The resulting value of all scenarios combined is r2=.46, which indicates that approximately 46% of the variance in behavior can be explained by understanding the attitudes that are measured by the DDSAS.

Discussion

There were two primarily goals for the study. The first was to create a new instrument, consistent with non-biased language as prescribed by the American Psychological Association (2010) that could be used to measure the attitudes held about the sexuality of individuals with developmental disabilities. The resulting instrument, Developmental Disabilities Sexuality Attitudes Scale (DDSAS), was found to be reliable and valid.

The second goal was to measure the attitudes about the sexuality of individuals with developmental disabilities that paid residential caregivers hold and to determine if those attitudes are correlated with intended behavior. A statistically significant and positive correlation was found between attitudes, as measured by the DDSAS, and intended behavior, as measured by the DDSSS. This is consistent with theory that suggests that attitudes and behavior should be very closely related (Rowe, Savage, Ragg, & Wigle, 1987). This also provides additional support for the validity of the revised (DDSAS) scale. Results indicated a high internal consistency of the DDSSS and statistically significant correlations between scores on the DDSAS and DDSSS. In addition, approximately 46% of the variance in behavior can be explained by understanding the attitudes held by paid residential caregivers about the sexuality of individuals with developmental disabilities.

Limitations of Study

One of the main limitations of this study is the small sample size in the main study. Managerial and staffing changes occurring in the company did not allow the researcher to have access to all employees. However, the pilot study sample provided adequate power for reliability and validity testing. Another limitation was that participants were told to apply statements in the DDSAS to individuals with mild developmental disabilities. This limits the generalizability of the results to other disability categories. Third, there were limitations of the generalizability of the main study results as the only job category that was included were paid residential caregivers. One cannot generalize these results to other professions that have contact with individuals with developmental disabilities. Finally, one should not infer any kind of causality between attitudes and intended behavior. The nature of the present study did not allow for causality to be ascertained, nor is it possible to understand the direction nature of the association (whether attitudes cause behavior or vice versa). The observation of behavior would be the more accurate way to measure reactions.

Recommendations for Future Research

There are several recommendations for future research. First, the study should be replicated using larger and more heterogeneous samples. This will improve generalizability. It would also be beneficial to continue to use the DDSAS and DDSSS together to strengthen the validity and reliability statistics for the DDSSS. Additional studies should also be completed with participants from different professions and backgrounds who work with individuals with developmental disabilities (medical, vocational, social work) to determine if there are differences in attitudes and predicted behaviors between these groups.

Implications for Practice

The instruments created in this study can be used to create training materials that can be used with paid residential caregivers and others who work with individuals with developmental disabilities. It would also be beneficial to use these instruments to gather data that can guide the creation of policies and procedures for those companies that provide services to these individuals. Using the instruments as a pre- and post-test, it is hoped that the training would bring the attitudes and predicted behavior closer in consistency to one another and in line to company policy and procedure. One of the main benefits of this study was the creation of two survey instruments that can be used in future research in the area of the sexuality of individuals with developmental disabilities. In addition, there is the potential to use the statements on the DDSAS to measure attitudes about the sexuality of other groups with or without modifications to the instruments. This could result in understanding more about the attitudes held about the sexuality of a variety of groups which could impact training and policies in a variety of areas. Once there is an understanding of these attitudes, it may be possible to continue the evolution of these attitudes to ensure the human rights of individuals whose sexuality is not understood or deemed inappropriate.

Table 1. Developmental Disabilities Sexuality Attitudes Scale (DDSAS)


Circle the choice that comes closest to your own feeling or opinion:
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
1. Sex education should be taught to individuals with developmental disabilities.
1
2
3
4
5
2. Adults with developmental disabilities should be able to date members of the opposite sex.
1
2
3
4
5
3. Adults with developmental disabilities should be able to have intercourse with one another.
1
2
3
4
5
4. Adults with developmental disabilities should be able to hold hands with members of the same sex.
1
2
3
4
5
5. Masturbation is a normal behavior.
1
2
3
4
5
6. Adults with developmental disabilities have the right to have children.
1
2
3
4
5
7. Adults with developmental disabilities should be encouraged to use birth control.
1
2
3
4
5
8. I feel comfortable answering a client's questions about sex.
1
2
3
4
5
9. Adults with developmental disabilities are vulnerable to rape by staff and people in the community.
1
2
3
4
5
10. Adults with developmental disabilities should be able to have oral sex with one another.
1
2
3
4
5
11. Adults with developmental disabilities should not be able to get married.
1
2
3
4
5
12. If an adult with developmental disabilities is found masturbating in private they should be discouraged from doing so.
1
2
3
4
5
13. As long as no one is being hurt, adults with developmental disabilities should be able to have sexual relationships.
1
2
3
4
5
14. Women with developmental disabilities should be prescribed birth control pills whether they are sexually active or not.
1
2
3
4
5
15. I encourage clients I work with to form relationships with other people.
1
2
3
4
5
16. Adults with developmental disabilities of the same sex should be able to have private time with one another.
1
2
3
4
5
17. Adults with developmental disabilities should be able to kiss members of the same sex.
1
2
3
4
5
18. If two adults with developmental disabilities of the same gender are found having intercourse it should be stopped.
1
2
3
4
5
19. Women with developmental disabilities are more likely to engage in sexual behavior than those of average intelligence.
1
2
3
4
5
20. Adults with developmental disabilities should be allowed to get married without permission of their guardian/conservator.
1
2
3
4
5
21. Adults with developmental disabilities have a lower than average sex drive.
1
2
3
4
5
22. If two adults with developmental disabilities of the opposite gender are found having oral sex it should be stopped.
1
2
3
4
5
23. I feel comfortable going with a client to purchase birth control.
1
2
3
4
5
24. Talking to an adult with developmental disabilities about sex would give them ideas that they would act on.
1
2
3
4
5
25. I would encourage a gay, lesbian, or transsexual client to data who they were interested in.
1
2
3
4
5
26. If clients ask questions about dating or sex they should be referred to the client's psychologist or psychiatrist.
1
2
3
4
5
27. Residential facilities should keep men and women with developmental disabilities apart as much as possible.
1
2
3
4
5
28. Adults with developmental disabilities should be sterilized if they want to be.
1
2
3
4
5
29. I feel comfortable answering a clients questions about birth control.
1
2
3
4
5
30. Handshakes are the only appropriate contact that should be made between adults with developmental disabilities.
1
2
3
4
5
31. Adults with developmental disabilities should be sheltered/protected from all matters regarding sex and sexuality.
1
2
3
4
5
32. Adults with developmental disabilities should be sterilized with or without their permission.
1
2
3
4
5
33. Adults with developmental disabilities should be able to date members of the same sex.
1
2
3
4
5
34. Adults with developmental disabilities should not be allowed to have sexual relationships.
1
2
3
4
5
35. Adults with developmental disabilities are more likely to engage in illegal sexual activities.
1
2
3
4
5
36. I feel comfortable discussing sex topics with a client who is gay, lesbian, or transsexual.
1
2
3
4
5
37. Adults with developmental disabilities should be able to masturbate.
1
2
3
4
5
38. Adults with developmental disabilities have the right to have sex.
1
2
3
4
5
39. Adults with developmental disabilities should have access to birth control.
1
2
3
4
5
40. Adults with developmental disabilities should be able to hold hands with members of the opposite sex.
1
2
3
4
5
41. I feel comfortable discussing a client's sex life with their guardian/conservator.
1
2
3
4
5
42. Adults with developmental disabilities are vulnerable to rape by other clients.
1
2
3
4
5
43. Adults with developmental disabilities should receive education about contraception and sexually transmitted diseases.
1
2
3
4
5
44. Adults with developmental disabilities who live in group homes should be allowed to have sexual relationships.
1
2
3
4
5
45. Adults with developmental disabilities have the right to make their own decisions about sex without approval of their guardian/conservator.
1
2
3
4
5
46. Adults with developmental disabilities who want to dress as the opposite gender should be able to do so.
1
2
3
4
5
47. Adults with developmental disabilities should be able to kiss members of the opposite sex.
1
2
3
4
5
48. Adults with developmental disabilities should be regularly tested for sexually transmitted diseases.
1
2
3
4
5
49. I encourage clients I work with to date other individuals.
1
2
3
4
5
50. Adults with developmental disabilities of the opposite sex should be able to have private time with one another.
1
2
3
4
5
51. Adults with developmental disabilities should be sterilized if their guardian/conservator wants them to be.
1
2
3
4
5
52. Adults with developmental disabilities should be allowed to get married but only with the permission of their guardian/conservator.
1
2
3
4
5
53. Adults with developmental disabilities who are gay, lesbian, or transsexual should be discouraged from sexual behavior.
1
2
3
4
5
54. Men with developmental disabilities are more likely to engage in sexual behavior than those of average intelligence.
1
2
3
4
5
55. I feel comfortable answering a client's questions about dating.
1
2
3
4
5
56. Adults with developmental disabilities should have access to adult (XXX) movies and magazines.
1
2
3
4
5
57. If two adults with developmental disabilities of the same gender are found having oral sex it should be stopped.
1
2
3
4
5
58. Adults with developmental disabilities should only be provided information about sex from a psychologist or psychiatrist.
1
2
3
4
5
59. Adults with developmental disabilities have a higher than average sex drive.
1
2
3
4
5
60. If an adult with developmental disabilities is found masturbating in public they should be discouraged from doing so.
1
2
3
4
5
61. If two adults with developmental disabilities of the opposite gender are found having intercourse it should be stopped.
1
2
3
4
5
62. Married couples with developmental disabilities should have residential facilities made available to them where they can live together.
1
2
3
4
5
63. Adults with developmental disabilities are not capable of making decisions about sex.
1
2
3
4
5
64. I feel comfortable answering a client's questions about oral sex.
1
2
3
4
5
65. Adults with developmental disabilities are asexual (no sexual needs).
1
2
3
4
5

Table 2. Question Coding Key Developmental Disabilities Sexuality Attitudes Scale (DDSAS)

Item
Strongly Agree=
Reverse Code
 
Item
Strongly Agree=
Reverse Code
1
Liberal
 
 
34
Conservative
Y
2
Liberal
 
 
35
Conservative
Y
3
Liberal
 
 
36
Liberal
 
4
Liberal
 
 
37
Liberal
 
5
Liberal
 
 
38
Liberal
 
6
Liberal
 
 
39
Liberal
 
7
Liberal
 
 
40
Liberal
 
8
Liberal
 
 
41
Liberal
 
9
Conservative
Y
 
42
Conservative
Y
10
Liberal
 
 
43
Liberal
 
11
Conservative
Y
 
44
Liberal
 
12
Liberal
 
 
45
Liberal
 
13
Conservative
Y
 
46
Liberal
 
14
Conservative
Y
 
47
Liberal
 
15
Liberal
 
 
48
Neutral
 
16
Liberal
 
 
49
Liberal
 
17
Liberal
 
 
50
Liberal
 
18
Conservative
Y
 
51
Conservative
Y
19
Conservative
Y
 
52
Conservative
Y
20
Liberal
 
 
53
Conservative
Y
21
Conservative
Y
 
54
Conservative
Y
22
Conservative
Y
 
55
Liberal
 
23
Liberal
 
 
56
Liberal
 
24
Conservative
Y
 
57
Conservative
Y
25
Liberal
 
 
58
Conservative
Y
26
Conservative
Y
 
59
Conservative
Y
27
Conservative
Y
 
60
Neutral
 
28
Neutral
 
 
61
Conservative
Y
29
Liberal
 
 
62
Liberal
 
30
Conservative
Y
 
63
Conservative
Y
31
Conservative
Y
 
64
Liberal
 
32
Conservative
Y
 
65
Conservative
Y
33
Liberal
 
 
     

Table 3. Developmental Disabilities Sexuality Situation Scale (DDSSS)

Scenario 1

When you bring a laundry basked full of laundry to a clients bedroom at 4 pm you knock on the door and hear what you believe to be permission to enter. When you enter the bedroom you find the client masturbating. The client is a 24-year old female who has been diagnosed with moderate mental retardation. She has difficulty understanding directions as her verbal communication is not completely developed. The company you work for does not have any policy about this type of situation. The client’s risk management plan does not address anything about sexuality. You know that the client’s family is very religious.

What is the likelihood you would take the following actions?
Very Likely
Somewhat Likely
Not Sure
Not Likely
Very Unlikely
A) Inform the client that the behavior needs to be stopped immediately.
1
2
3
4
5
B) Ask the client to stop the behavior and speak to the client later about the behavior.
1
2
3
4
5
C) Leave the room without saying anything and leave a note so that the behavior can be addressed by their psychologist. You don’t address the behavior.
1
2
3
4
5
D) Excuse yourself, leave, and speak to them later about the behavior.
1
2
3
4
5
E) Excuse yourself, leave, and sit down the client later and reinforce the behavior as being appropriate in the environment that they were doing it in.
1
2
3
4
5

Reverse score choices A & B so that a 1 equals the most tolerant choice and 5 equals the least tolerant for all items.



Scenario 2

You walk into the living room and find two male clients sitting on the couch holding hands. These two clients are friends but not housemates. You work with one of the clients who has been diagnosed with mild mental retardation and is high functioning. He has identified himself as gay many times. You do not work directly with the other individual but also know that he has identified himself as gay.

What is the likelihood you would take the following actions?
Very Likely
Somewhat Likely
Not Sure
Not Likely
Very Unlikely
A) Inform the client that the behavior needs to be stopped immediately.
1
2
3
4
5
B) Ask the client to stop the behavior and speak to the client later about the behavior.
1
2
3
4
5
C) Leave the room without saying anything and leave a note so that the behavior can be addressed by their psychologist. You don’t address the behavior.
1
2
3
4
5
D) Excuse yourself, leave, and speak to them later about the behavior.
1
2
3
4
5

E) Excuse yourself, leave, and sit down the client later and reinforce the behavior as being appropriate in the environment that they were doing it in.

1
2
3
4
5

Reverse score choices A & B so that a 1 equals the most tolerant choice and 5 equals the least tolerant for all items.



Scenario 3

You walk into the living room and find a 21 year old female client and her boyfriend sitting on the couch kissing. The client’s family has made statements in the past that has led you to believe that they are not comfortable with this client’s developing interest in boys or her developing sexuality.


What is the likelihood you would take the following actions?
Very Likely
Somewhat Likely
Not Sure
Not Likely
Very Unlikely
A) Inform the client that the behavior needs to be stopped immediately.
1
2
3
4
5
B) Ask the client to stop the behavior and speak to the client later about the behavior.
1
2
3
4
5
C) Leave the room without saying anything and leave a note so that the behavior can be addressed by their psychologist. You don’t address the behavior.
1
2
3
4
5
D) Excuse yourself, leave, and speak to them later about the behavior.
1
2
3
4
5
E) Excuse yourself, leave, and sit down the client later and reinforce the behavior as being appropriate in the environment that they were doing it in.
1
2
3
4
5

Reverse score choices A & B so that a 1 equals the most tolerant choice and 5 equals the least tolerant for all items.



Scenario 4

You hear noises coming from a male client’s bedroom. This client has a history of seizures so you walk into the room without knocking to make sure that he is ok. When you walk in you find him and his girlfriend in bed together. They have been in a relationship for quite a while and the male client has been diagnosed with moderate mental retardation. He has had training from his psychologist on sexuality and has been taught how to use condoms. His girlfriend is her own guardian but he is not.

What is the likelihood you would take the following actions?
Very Likely
Somewhat Likely
Not Sure
Not Likely
Very Unlikely
A) Inform the client that the behavior needs to be stopped immediately.
1
2
3
4
5
B) Ask the client to stop the behavior and speak to the client later about the behavior.
1
2
3
4
5
C) Leave the room without saying anything and leave a note so that the behavior can be addressed by their psychologist. You don’t address the behavior.
1
2
3
4
5
D) Excuse yourself, leave, and speak to them later about the behavior.
1
2
3
4
5
E) Excuse yourself, leave, and sit down the client later and reinforce the behavior as being appropriate in the environment that they were doing it in.
1
2
3
4
5

Reverse score choices A & B so that a 1 equals the most tolerant choice and 5 equals the least tolerant for all items.



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