• Patients with disabilities have rights to assent or decline the examination, or to participate with DFPS or law enforcement investigation.
• Individuals presenting with disabilities may exhibit a wide range of skills and functioning.
• Disability may involve physical impairment, sensory impairment, cognitive or intellectual impairment, mental disorder, or various types of chronic disease.
• Ask patient and/or guardian or family member for direction on patient’s abilities, and how to best support those abilities.
• Refrain from collecting any adaptive devices, even if it believed there may be evidence of an assault. Consider alternative collection techniques, such as photography and swabbing

Mandatory Reporting

Texas law (Family Code §261.101 and Human Resources Code §48.051) mandates that anyone who believes a child (under 18 years of age), person 65 years or older or an adult with disabilities“Person with a mental, physical, or intellectual or developmental disability that substantially impairs the person’s ability to provide adequately for the person’s care or protection and who is: (A) 18 years of age or older; or (B) under 18 years of age and who has had the disabilities of minority removed (Texas Human Resources Code §48.002). More is being abused, neglected, or exploited must report it to DFPS. This responsibility cannot be delegated to another person.

A person who reports abuse in good faith is immune from civil or criminal liability. DFPS keeps the name of the person making the report confidential. Anyone who does not report suspected abuse can be held liable for a misdemeanor or felony.

Call the DFPS Abuse Hotline toll-free 24 hours a day, 7 days a week, nationwide, or report with secure website (reporter receives a response within 24 hours):

• Telephone: 1-800-252-5400
• Online report

Key Considerations for Patients with a Disability

• See ADA.gov
• It is important for medical professionals to understand the individual’s ability and how to best accommodate the individual to avoid further trauma.
• For example, an individual with a hearing impairment may require a sign language interpreter; however, having the interpreter in the exam room may be inappropriate. The examiner should use clinical judgment.
• Ensure the patient’s needs for privacy and confidentiality are met (e.g., during anogenital exam) if interpreter is in the room.
• An individual diagnosed with a seizure disorder may exhibit certain behaviors prior to a seizure occurring. It is important to be aware of these signs should the individual have a seizure during the examination.
• Utilize person-first language in oral and written communications. Person-first language refers to individual with differing abilities as people first. For example, instead of saying “an autistic patient,” utilize “a patient with autism.”
• It is best practice when requesting a sexual assault advocateVolunteer or paid professional who understands sexual violence and victim dynamics, who is highly trained and trauma-informed and can address with expertise the short- and long-term needs of patients who report sexual assault. May serve military or civilian families. Texas Government Code §420.003 and Texas Code of Criminal Procedure §56A.351 describe presence of an advocate and mandatory training requirements. Also see sexual assault prevention and response victim advocate (SAPR). A support person is not the same as an advocate with specialized education., to ensure that the sexual assault advocacy program is informed that the patient or support person(s) has a disability so they can accommodate as needed.
• If possible, the provider should find out the individual’s baseline social/emotional/behavioral functioning prior to the abuse, as well as the level of independence, skills sets and interests.
• Many individuals with disabilities know their abuser.
• Be calm, literal and concrete.