Assessing Competency to Consent to Sexual Activity in the Cognitively Impaired Population

Sexuality is an integral factor when considering quality of life. Psychologists and mental health providers have a responsibility to promote patients' rights to sexual expression, but also to protect patients when impairments interfere with the ability to make informed decisions. Rehabilitation facilities struggle with this issue, especially the question of ability to consent. The Sexual Consent and Education Assessment (SCEA), a tool which evaluates an individual's capacity to consent to sexual activity, was developed and administered to 80 cognitively impaired adults. Of the subjects, 69 had varying degrees of mental retardation, and 11 had traumatic brain injuries. Participation in the study consisted of an interview with each individual and a person who worked closely with him or her. Competency was defined as: understanding the nature of sexual conduct, understanding possible consequences, and possessing the ability to make safe choices. Scores were compared to independent interdisciplinary team evaluations and participant characteristics. The instrument had high internal stability and interrater reliability, satisfactory testretest reliability and its determination had high predictive validity with the team decisions. The ability to consent was related to psychometric intelligence, previous sexuality education, current sexual behavior and adaptive behavior age scores. Current results indicate that the Sexual Consent and Education Assessment is useful for psychologists, neuropsychologists, and forensic psychologists because it addresses both prescriptive and diagnostic issues of sexual competency in the cognitively impaired population.