People receiving residential mental health treatment are legally entitled to exercise their rights and freedoms to the extent that is safe and that does not interfere with recovery (Americans with Disabilities Act, 1990; Ford, Rosenberg, Holsten, & Boudreaux, 2003). Despite this, sexual activity in residential treatment settings is often prohibited through both formal and informal means (Buckley, Hogan, Svendsen, & Gintoli, 2013; Wright, McCabe, & Kooreman, 2012). One barrier to lessening restrictions on the sexual liberties of residential clients is the lack of guidelines for determining the capacity to consent to sexual activity (Buckley & Wiechers, 1999; Parker & Abramson, 1995). Providing guidelines for assessing the capacity to consent could provide opportunities for some clients to engage in dignified sexual expression and could help practitioners to identify others who may not be capable of making safe sexual decisions. In a preliminary step toward the creation of such guidelines, this qualitative study explores how administrators, staff, and former clients of residential facilities define and conceptualize the capacity to consent to sex. These stakeholder-endorsed definitions might later serve as frameworks from which guidelines and methods of assessment could be developed. This study also explores factors identified by administrators, workers, and former clients of residential facilities as impacting the capacity to consent, as they define it. This is another important preliminary step toward creating best practices for determining the capacity for sexual consent among clients of residential mental health programs. Nonprobability sampling was used to recruit 15 participants, 5 from each stakeholder group: administrators, staff people, and former clients. An in-person, semi-structured interview with each participant was conducted. Interviews averaged 69 minutes and elicited information about how participants define and conceptualize the capacity to consent to sexual activity as well as the factors perceived to enhance or reduce that capacity. Analysis of interview data used a hierarchical coding process based on Strauss and Corbin's (1990) constant comparative method and Scott's (2004) conditional relationship guide. To enhance the rigor of analysis, a variety of reflexive writing practices were used, and researcher analysis was shared with participants, who were invited to provide statements about where the analysis diverged from their opinions and experiences. The common themes observed in participant definitions of capacity for sexual consent were that capacity for consent includes the ability to give and receive communication about consent, that capacity for consent includes an understanding of contextual information about the sexual encounter, and that capacity for consent includes an understanding of one's own internal desires. Factors identified by stakeholders as affecting residential clients' capacity for sexual consent were intelligence or sexual knowledge, intoxication, confusion, delusions, general mental status, difficulty refusing others, having vacillating feelings about sexual encounters, and using sex as a tool. Participants considered many of these factors transient, indicating that capacity to consent is not viewed as a stable trait. In addition to information directly pertinent to the research aims, stakeholders identified several practical barriers to allowing sex in residential treatment settings. These include the perceived responsibility of providers for the consequences of sex, the lack of private space, the potential to disrupt the treatment environment, and the potential for sex to result in retraumatization or interfere with recovery. This work concludes with recommendations for practice and further research. In particular, the definitions of capacity for sexual consent identified by participants in this study should be evaluated by a representative group of stakeholders in residential mental health to determine their salience and legitimacy more broadly. Further, factors proposed to enhance or reduce the capacity for consent in the study should be empirically investigated to determine whether they do have actual impact on sexual decision making. / A Dissertation submitted to the College of Social Work in partial fulfillment of the Doctor of Philosophy. / Spring Semester, 2015. / March 2, 2015. / capacity to consent, mental health, psychiatric social work, sexual behavior / Includes bibliographical references. / Tomi Gomory, Professor Directing Dissertation; Amy Burdette, University Representative; Jean Munn, Committee Member; LaTonya Noël, Committee Member.
| Identifer | oai:union.ndltd.org:fsu.edu/oai:fsu.digital.flvc.org:fsu_253048 |
| Contributors | Thomas, Jill Gromer (authoraut), Gomory, Tomi (professor directing dissertation), Burdette, Amy M. (university representative), Munn, Jean C. (committee member), Noël, LaTonya M. (committee member), Florida State University (degree granting institution), College of Social Work (degree granting college), College of Social Work (degree granting department) |
| Publisher | Florida State University, Florida State University |
| Source Sets | Florida State University |
| Language | English, English |
| Detected Language | English |
| Type | Text, text |
| Format | 1 online resource (217 pages), computer, application/pdf |
| Rights | This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). The copyright in theses and dissertations completed at Florida State University is held by the students who author them. |
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