The interview.

An interview guide was developed to standardise the process and provide a comprehensive assessment framework. It was devised to promote best practice and is inclusive of many more details than is the focus of this research, but provided useful information for on-going evaluation of the programme and a collection of data for possible further formal research. The interview guide provided the basis for the information included in the database. The development of this guide is discussed more fully in the section detailing of the development of the database. (section 4.8.1.) Detail of the interview guide is included in Appendix F and included the following categories:

• Identifying information. • Referral.

• Personal history. • Family history.

In particular, the socioeconomic status (SES) of the family was evaluated as described previously. This was then categorised as below the poverty level, low SES, middle SES or high SES. The overwhelming majority of our clients come from impoverished circumstances and fell into the category of low SES or below the poverty level.

Various social grants are available through the government Department of Social Development. Access to grants was documented. A care dependency grant or a disability grant are the two most common categories of grants available to support families with a member who is intellectually disabled. There is also a child care grant and foster care grant available through the state. Documenting this also served to flag the need for action on the part of the social worker case manager. Details are given in the literature review (section 3.3.4.).

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• Assault history.

This was an important aspect of the assessment process, although some aspects were not reported on directly as the information was sub judice (under judicial

consideration and public discussion is prohibited). However, it formed an important component of the evaluation regarding competency to give evidence.

• Appearance and behaviour at assessment • Adaptive functioning assessment.

The Vineland Adaptive Behavior Scales were administered. In the period between 2005 and 2011 the VABS (1984) was used. The VABS II (2005) was introduced and phased in from 2009 until 2011 when it was used exclusively to assess adaptive functioning.

4.7.1.5.1. Use of different norming tables for adults.

If a different set of norms was used by the psychologist to calculate scores for the VABS II (i.e., the 18-21.11 norms for adults due to the floor effects in the older age

categories), this was noted and the norms for the appropriate age category were entered into the database to allow for statistical analysis of the published norms. Refer to the discussion chapter for more detail on this issue (section 7.10.).

• IQ assessment.

The ISGSA was used as part of the assessment of all those included in this study. This is a test normed on a South African population of English and Afrikaans speakers (refer to the previous measurement instrument section for details). There are norms from four years of age to 16 years. Our clients’ cognitive development generally fell within this range. For those who were higher functioning or had other physical disabilities such as sight or hearing or motor difficulties, alternative tests were used which were more appropriate. (Refer to the exclusion section of this chapter for detail (4.6.2.)and Appendix E.)

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• Understanding of sexual matters.

The ability to consent to sexual intercourse was evaluated against the legal definitions given in the South African Criminal Law (Sexual Offences and Related Matters) Amendment

Act 32 of 2007. The Act defines mental disability being inclusive of any disability or disorder

of the mind at the time of the alleged offence in that he or she was:

a. unable to appreciate the nature and reasonably foreseeable consequences of a sexual act;

b. able to appreciate the nature and reasonably foreseeable consequences of such an act, but unable to act in accordance with that appreciation;

c. unable to resist the commission of any such act; or

d. unable to communicate his or her unwillingness to participate in any such act. (Section 57 (2))

This is in line with Williams' (2008) understanding of the elements of consent as including:

• information;

• capacity (ability to understand the information, apply it to oneself and make decisions);

• voluntariness (freedom to decide).

The following areas were explored with the client:

• their understanding of the physical mechanics of sexual intercourse; • their interest and knowledge of sexual matters;

• previous sexual history both consensual and non-consensual; • their understanding of conception;

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• sexually transmitted disease, with particular reference to HIV/AIDS in order to explore their understanding of the consequences of sexual intercourse and the need for protective action.

Through this process, their sexual vocabulary was assessed, including commonly used terms in their community, as was the sources of their sex education being through school, home, the media or through other means. The ability to refuse was evaluated and an overall assessment made and recorded using this information. Use was made of anatomically correct dolls and pictures demonstrating consensual and non-consensual touching and sexual

foreplay and sexual intercourse (Johns, 2005). (Refer to Appendix G.) There is ongoing discussion in the literature regarding the relationship between level of intellectual disability, sexual rights and the ability to consent to sexual intercourse (Benedet & Grant, 2013; Dickman, 2017; Murphy & O’Callaghan, 2004). Reflection and examination of best practice of this part of the assessment is outside the scope of this research but is very pertinent to the work of the project and is a point of ongoing discussion and debate.

• Competence as a witness.

The clients’ understanding and knowledge of court proceedings was evaluated. The ability to differentiate truth and falsehood was explored at both a concrete and abstract level. The tool used was developed by Lyon and Saywitz (2000). Their concept of perjury and their understanding of what it means to promise were important components of their readiness for the court process, their ability to be a reliable witness and exploratory in terms of, if with further court preparation, they would be a competent witness.

Their ability to give a narrative, sequential, consistent account of the alleged incident was evaluated over two tellings. The anatomically correct dolls were also available, if needed, to assist. Some clients could not verbalise their experience but could demonstrate with the dolls. Their ability to answer simple clarifying questions was also evaluated.

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Their motivation to testify was explored and categorised as motivated, wanting justice but ambivalent, no understanding of the injustice, that the sexual activity was not a crime, or they were afraid of the consequences of testifying. In the great majority of cases the use of an intermediary was recommended (96%). This was often an opportunity to do initial court preparation and to give a careful explanation of court process. An overall assessment was recorded, often with the proviso of further adequate court preparation and given the understanding of the court of the limitations of the witness and giving the complainant appropriate support (refer to the results chapter for the number of clients found to be

competent witnesses and the support requested (section 5.3.3-6)). The competence of people with intellectual disability to give evidence and participate in court processes is also an area of ongoing debate and discussion and is important in realising access to justice for this vulnerable group (Bala, Lee, Lindsay, & Talwar, 2010; Benedet & Grant, 2013; Meintjies, 2015; Gentle et al., 2013; Pillay, 2012; Van Niekerk, 2014).

• Psycho-legal report and legal process.

Findings were written up in a psycho-legal report and submitted to the investigating officer or the prosecutor depending on the pathway of the referral. The outcome of the assessment was fed back to the client, their caregiver and the referrer. If the client was found unable to give evidence, this was carefully explained. This process, together with the usually long wait for a court date, was explained to the client and their caregiver at the closure of the interview. Wherever possible, the client was referred back to the appropriate social work services, either within the organisation, or services in the geographic area for those clients residing outside of the Cape Town metropole for ongoing support and court preparation. Whenever possible, the social worker would accompany the client and their family to court on the date of court appearance. The assessing psychologist would often be called as an expert witness to present their report and findings to court and answer questions from the

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legal team. This was often an opportunity to advocate for and educate regarding the needs and rights of people with intellectual disability and correct misconceptions. Wherever

possible, this was prior to the client being called to give evidence in order to prepare the court for the needs of the client. The aim was to prepare the court for the client and the client for court.

Ongoing areas of difficulty in terms of the legal process are: the length of wait between reporting the alleged assault and appearance in court, the families and clients not being informed of the outcome of the trial, and ongoing education of the police and officers within the legal system regarding the particular needs of people with intellectual disability. 4.8. Data collection for this study

Retrospective information was gleaned from a basic interview schedule, the test protocols, the notes and psycho-legal report of the assessing psychologist on file for this period of 2005 to 2010 when the VABS (1985) was used. With the conceptualisation of the research and the development of a more detailed interview schedule, data were collected with the VABS II (2005) from 2010 until the end of 2013.

The hard copy of the client file and psychologist report was examined and relevant quantitative and qualitative data extracted and entered into a data set. Quantitative item scores for each subdomain were entered, together with the relevant total scores and derived scores. The concluding evaluation of the clinical psychologist in terms of level of disability, as reported on the court report, was recorded. Qualitative information regarding age, gender, race, socioeconomic status, access to education, geographic distribution, language, evidence and degree of trauma was included. The use of racial categories is controversial as to further entrenching divisions. Given the South African context and history, race continues to be linked to economic, social and resource inequity. The categories used of African, Coloured, White and Indian/Asian concur with those used in the present census data for South Africa

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(Statistics South Africa, 2017). It is acknowledged that race is a social construct, but continues to play a determining role (refer to literature review, section 3.2.2).

4.8.1. Development of the interview schedule to enable the collection of data.