Abuse of Individuals with Disabilities

1. Abuse of Individuals with Disabilities Dr. Sara Plummer Rutgers University

2. Overview History of abuse Prevalence rate Types of abuse Risk factors Screening

3. History • 660 BC – Ancient Greece – • The Spartans threw babies born with disabilities over a cliff • It was assumed they would not be able to adequately contribute to society • The Athenians placed unwanted infants in jars and then left them in temples for people to adopt

4. History • Euthanasia – the intentional putting to death of a person with an incurable or painful disease • Nazi euthanasia program initially targeted people with severe mental and physical disabilities (more than 100,000 mental hospital patients and 5,00 children with developmental disabilities were killed between 1939 and 1941)

5. American History Eugenics – the science that advocates for the improvement of genetic qualities (Sir Francis Galton – Darwin) More than 300,000 individuals in special education programs, residents in institutions with intellectual disabilities were sterilized

6. American History • 1800’s – restrictive marriage and reproduction laws – that prohibited marriage and intercourse amongst individuals with developmental disabilities and epilepsy • Many states had laws that allowed and encouraged the use of eugenics. VA - 1924, passed the Eugenic Sterilization Act, • Act called for sterilizations based on the intent: 1. to promote an individual's health or 2. to protect the welfare of society.

7. American History By 1930’s over half of the states had eugenic laws giving doctors the right to forcibly sterilize individuals deemed “unfit” to reproduce VA test court case Buck vs. Bell (MD) Carrie Buck - identified as having epilepsy and being feebleminded) – was committed to the Lynchburg Colony for the Epileptic and Feebleminded (asylum or institution) after giving birth to a baby girl

8. American History • Described as promiscuous, sterilization was seen as logical fix to end generations of the “feebleminded” and an “imbecile” • Mother and child were deemed also to have intellectual disabilities

9. American History • Carrie and family fought sterilization and it went to Supreme Court ; Ruling 8:1 against Carrie • Judge who wrote decision, Oliver Wendell Holmes said: "Three generations of imbeciles are enough.“ (Carrie’s mother has similar diagnosis) • End note – Carrie was raped by a family member and likely sent away to hide this fact, later she and her daughter were found to have no significant intellectual disabilities, her sister was also sterilized

10. American History • From 1927 – 1972 – doctors at this hospital alone sterilized more than 8000 individuals including those with intellectual disabilities and those without disabilities

11. American history • 1941 Foster Kennedy, MD presented “The Problem of Social Control of the Congenital Defective: Education, Sterilization, Euthanasia“ to the American Psychiatric Association • He proposed the killing of “hopelessly unfit” children with developmental disabilities by age 5 • "I believe when the defective child shall have reached the age of five years . . . that the case should be considered under law by a competent medical board." The board would be authorized "to relieve that defective . . . of the agony of living.“ • This was seen as purification through extermination and a natural step in evolution

12. Prevalence Individuals with disabilities experience abuse at similar or increased rates Life time rates of abuse 62% for both individuals with disabilities and general population (Young, et al. , 1997) In a study of physical and sexual abuse, physical rates were equal and sexual abuse was 4 times higher for individuals with disabilities (Martin, et al, 2006) In a study of over 1000 women in family practice clinics, those who reported experiencing abuse were 2 times more likely to report having a disabilities

13. Prevalence • Studies also suggest that women with disabilities experience abuse for longer periods of time and by more perpetrators • The research does not truly estimate the prevalence due to lack of: • Screening • Outreach • Accessible services • No attempt to seek services since little to none are available

14. Types of abuse • Individuals with disabilities suffer from multiple forms of abuse • Physical, sexual, emotional, economic • Also experience disability related abuse • Denying access to mobility devices • Preventing them from accessing medical care • Neglecting personal care • Withholding medications

15. Examples of disability related abuse • Refusal to aid in toileting • Over or under-medication • Breaking communication and mobility devices • Wheelchair, TTY, pager, prosthetic limb • Moving furniture in a home of a visually impaired person • Taking away a prosthetic limb • Mistreating service animals

16. Examples of disability related abuse • Force the person to allow them to become the representative payee • Threatening to report them to DYFS • Historically courts have ruled against women with disabilities • Threatening to institutionalize them

17. Risk Factors Some suggest having a disability in this world immediately places that person at risk Research has suggested some specific risk factors

18. Isolation • Isolation creates a barrier to support and services • Individuals who are less mobile, and more socially isolated have a higher likelihood of experienced abuse (Nosek et al, 2006) • Isolation can be a result of • Lack of accessibility • Lack of mobility • Social isolation • Lack of transportation

19. Perpetrators • Individuals with disabilities are exposed to multiple potential abusers • This population is at risk by the sheer number of people they come into contact with • Intimate partners • Family members • Health care providers • PAS workers • Ambulance drivers

20. Perpetrators • Intimate partners are the most commonly identified perpetrators of domestic violence including husbands and live in partners • Perpetrators of sexual violence are most often people they come into daily contact with but not people they live with • Most often men are identified as the perpetrator

21. Perpetrators in Relationships • Certain predatory individuals may view a romantic relationship with a person with a disability as an opportunity for exploitation, mistreatment and abuse • An individual may specifically target individuals they believe to be vulnerable and intentionally seek out individuals they believe they can exploit, mistreat and abuse • The expectation may be that the woman will not be believed if she reports abuse • Which is often the case • Less likely to resist or fight back

22. Perpetrators – family Family members – parents and siblings who have limited patience or regard for the individual may become abusive Some parental relationships become strained due to the additional needs of a child with a disability – the child is then blamed for the break down in the marriage and in turn abused or neglected Siblings may become jealous due to the added attention the child receives as a result of the disability and may act out towards the child

23. Perpetrators – Service Providers • PAS, Healthcare workers, group home worker • The nature of the relationship between individual and worker is viewed as a risk factor • Ongoing contact (many hours in the home, time spent in day treatment programs, etc) • Intimate nature of contact (bathing, toileting) • Blurring of boundaries (worker vs. friend/partner) • Perpetrators may enter the field in order to specifically target this population • Perceived vulnerabilities and opportunities

24. Dependency • Perpetrators may have the role of both partner and primary caregiver • Physical, emotional and financial dependency may increase the risk of abuse and limit one’s ability to leave • This creates a dichotomous and confusing relationship of abuser and caregiver • An abused individual will be fearful of losing their source of daily care • As a result the abused individual may feel he or she needs to compromise or accept the abuse to continue to receive the benefits of the relationship (Hassouneth –Phillips, 2005)

25. Learned Helplessness/Compliance • Children with disabilities may experience: • Overprotection (no allowing child to experience various things) • Segregation (separation in schools) • Isolation (lack of social networks) • Limited autonomy (told to comply with doctors, nurses) • Creates lack of understanding of social cues and increases potential for learned compliance as adults • The attempt to protect a child or make less of a “burden” may inadvertently facilitate situations that are potentially abusive

26. Learned Helplessness/Compliance • Creates individuals who are overly agreeable, and accommodating • Individuals are taught to comply with other’s wishes early on in life • Creates a fear of “rocking the boat” and avoids stating one’s needs • Compliance is then over generalized to other individuals and situations in life

27. Lack of Identification • Abuse against individuals with disabilities often goes unrecognized • Due to nature of abuse which often targets the person’s disability • These behaviors are often not defined as abuse by state laws • The person often does not realize the behavior is abusive

28. Lack of identification • May not tell others for fear of disbelief • People don’t want to believe this occurs so will dismiss it • The person accused is viewed as an upstanding citizen, may be a person of authority • People with disabilities are historically not seen as reliable sources of information • Lack of knowledge about victimization • Do not know who to contact • There are not many places to go for help

29. System and Cultural Barriers • Lack of accessible resources • Lack of accessibility • Limited physical access • No interpreters • Attitudinal barriers • Disability organizations in general have lack of information and resources on abuse • Lack of capacity to address issue (screening, resources, referral) • Historically attempts at seeking help has been met with insensitivity • Lack of coordinated response – disability and DV or SA

30. System and Cultural Barriers • Oppression and devaluation of women with disabilities • Ableist and sexist view points • Negative valuations of individuals with disabilities • Seen as less than (not the ideal female form)

31. System and Cultural Barriers • Discrimination and oppression become internalized • Creates self devaluation and poor self esteem • Women with disabilities report overall high rates of low self esteem • This translates in a fear of being alone • Doubts another partner would want to be with them • Lack of worthiness around being in a relationship • May blame themselves for the abuse

32. Tips for serving survivors with disabilities • Screening • Always screen for abuse • There remains a lack of screening across disciplines

33. Screening You can begin to screen all clients who you encounter Has anyone ever hit, slapped, kicked, pushed, shoved, or otherwise physical hurt by someone? Has anyone ever forced you to engage in sexual activities? Has anyone ever threatened, intimidated, coerced or manipulated you to do things you did not wish to do, done or said anything to make you feel fearful, or humiliated, overly criticized, or bullied you? * it is important to ask about lifetime history and current history (i.e. within the last year or 6 months)

34. Screening • Then ask disability related abuse questions • Has anyone prevented you from using a wheelchair, cane, respirator, or other assistive devices? • Has anyone you depend on refused to help you with an important personal need, such as taking your medicine, getting to the bathroom, getting out of bed, getting dressed, or getting food or drink? • Within the last year, did someone take your SSI or SSD check, a paycheck, or financial aid check without your permission, refuse to allow you to access your bank account, or restrict your use of money, a debit or credit card?