There has been a lot in the news recently about a woman in a vegetative state who gave birth a few weeks ago after being a resident for 10-plus years at Hacienda Healthcare, a skilled nursing facility in Phoenix. Shortly thereafter, police served a search warrant to obtain DNA from a male who works at Hacienda. Not too long after, a licensed practical nurse was arrested and charged with sexual assault and abuse of a vulnerable adult. Later, news clarified the woman was not in a vegetative state, and she is able to recognize and enjoy the company of family.

While an arrest was made fairly quickly, it might not have been so. As Nora Baladerian, Ph.D. and director of the Disability and Abuse Project, wrote recently, "Everyone with access to this woman had opportunity - possibly over 100 men, all the staff from custodial staff to the executive team, all board members and their spouses, the volunteer program director and all volunteers." What about visitors - to this patient and other patients - who may pass the word that they can "get them in" to the hospital? Could it be a human trafficking program operating right under the noses of staff? What about the physicians? The psychiatrists and psychologists who visit the patients? The nurses' aides, the physical therapists, speech therapists, occupational therapists? What about those who conduct cleaning services including janitors, laundry personnel? What about suppliers to the hospital who bring food and other supplies? Not to mention transportation providers, who may take other patients for medical or other appointments. These providers are frequently identified as perpetrators of sexual abuse. Keep in mind that many predators have no record or may have provided false records.

So, more generally, my questions are: What risk reduction procedures does an agency that provides residential services to vulnerable adults have in place to prevent sexual abuse? What are these strategies? When is the training? How often is training given? What vigilance processes are there in place to protect the safety and well-being of each person? What are the administrative practices to ensure the safety of all patients?

My question, is do these agencies provide copies of these procedures to residents, their guardians and their family?

Abuse is an epidemic for people with developmental disabilities. In fact, the prevalence is more than three times greater than for people without disabilities. Baladerian has written risk reduction programs for self advocates, schools, parents and providers. She has also developed a program that any agency such as Hacienda Healthcare can adopt. It is called the Abuse Aware Agency whereby "participants become keenly aware of the risks of abuse for the population they serve. Policies and practices are recommended to fill gaps discovered in administrative review. Individual needs are reviewed for each patient to insure their well-being. Staff receive monthly training in abuse awareness and reporting. Programs are instituted to support staff when they may be afraid to report abuse as there may be threats against them by the perpetrator that leads to silencing the voice of these mandated reporters. Agencies such as Hacienda should conduct not only a thorough investigation and analysis of this case, but re-design their current policies and practices through each level of governance and responsibility, including staff training, patient care, and safety."

I have tried to shed light on some of the issues of this one woman's sexual assault and on the heightened vulnerability of men and women receiving residential services. I am asking administrators and residential agency providers in this area to participate in an AAA training program if they don't have one in order to reduce the significant risk of abuse for people with disabilities and other vulnerable adults. Furthermore, if you have a family member with a development disability or are a guardian of a vulnerable adult who receives residential services, I urge you to ask what the provider is doing to protect clients from abuse and to ask for copies of these procedures. Remember, perpetrators think they won't get caught. We need to send a loud and clear message that abuse of people with disabilities will not be tolerated, that people are watching and reporting, and that law enforcement and courts will respond.

Tina Baldwin lives in Moscow and leads abuse risk reduction workshops for people with developmental disabilities, parents, service providers, police departments and other interested groups.

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