An Overview of Violence Against Children with Disabilities

2. An Overview of Violence Against Children with Disabilities Presented by: Nora J. Baladerian, Ph.D., CST, BCFEDisability, Abuse & Personal Rights Project & CAN DO! Project of Arc RiversideChild Abuse & Neglect Disability Outreachfor the BEST PRACTICE II CONFERENCE 2004 On Child Abuse & Neglect Mobile & Birmingham, Alabama

3. Prevalence of Violence Against Children with Disabilities • How many are there? • People with Disabilities are said to constitute approximately 20% of the population, with 10% having severe disabilities (DOL) • There are current increases in certain types of disability due to: • Violence - Longer life spans • Accidents - Improved medical care

4. Who are Children with Disabilities? • Children born with disabilities • Children who acquired disabilities as children through accident or illness • Children who acquired disabilities as a result of criminal behavior by others • Children who acquired a disability by other means

5. What kinds of disabilities are included? • Sensory • The 5 senses: hearing, vision, touch, taste, smell (NOTE: The 6th sense does not seem to be impacted by the disability!! Interesting, eh?) • Communication • Mobility Impairment • Intellectual • Social (Characterological or Autism Spectrum) • Psychiatric (Bio-Medical, thought disorders) • Medical including Neurological, Endocrine, etc. • Orthopedic • Respiratory

6. Hey, What about Developmental Disabilities? • “Developmental Disability” is a legal term that exists at both the federal and state levels. • The “theme” is to identify people whose normal developmental progress is changed due to a disability that causes a need for specialized interventions and services. • In most states, people with mental retardation have constituted the highest percentage of those with developmental disabilities, although with the increase of about 600% in the incidence of autism over the past 10 years, the balance has changed.

7. Data on Prevalence of Abuse shows that Children with Disabilities are: • 3.4 times more likely to be abused than others (Sullivan, 2001) • 1.7 times more likely to be abused than others (Westat, 1991) • 4-10 times more likely to be abused than others (Garbarino, 1989) Adults with Disabilities are: • Equally as likely to be abuse victims as the generic population (Nosek, 1999) BUT • The extent of the abuse is much worse for women with disabilities. • Have equal vulnerability as children with disabilities (Baladerian,, 2001 [anecdotal]) (Why would it be different, since vulnerability transcends age categories)

8. Other studies show… • Increased rates of abuse by both men and women with disabilities from 31-83% • For women with mental retardation & other intellectual impairments rates from 40-90% • Approximately 5 million vulnerable adults annually become crime victims. (NAS, Petersilia, 2001) • Approximately 2 million elders per year have substantiated abuse cases.

9. Children (0-18 years of age) • Approximately 1 million children (generic) per year have substantiated abuse cases. • Estimates 1 in 4 girls, 1 in 7 boys • How does that work for kids with Disabilities? • 12% of those would have Disabilities BUT increased rates of abuse change that...what is 1in 4 x 3.4? • 1 in 4 = 25% x 3.4 = 85% • 1 in 7 = 14% x 3.4 = 47.6% • 1 in 4 = 25% of girls of whom 12% likely have a disability, .12 x 25 = 3% x 3.4 = 10.2

10. Overview of Abuse & People with DisabilitiesChildren with disabilities are abused more than generic kids by a factor of • 1.7 DHHS/NCCAN, 1991,Westat • 3.4 Boystown Research Hospital, 2000, Sullivan • 7 Compilation of smaller studies from 1982 to date

11. Boystown Research Population Sample:1. Hospital based study to identify prevalence of disabilities among maltreated versus nonmaltreated children, researchers merged >39,000 hospital records from 1982 to 1992 with the social service central registry, the foster care review board and police records for both intra and extra familial maltreatment. Merger resulted in 6,000 matches, an overall maltreatment prevalence rate of 15 percent.

12. Among the 15% maltreated, 64% had a disability,Of the nonmaltreated 32% had a disability.

13. Boystown Study continued...Identified disabilities of the hospital based study included:Behavior disorders 38%Speech/language disorders 9%Mental retardation 6%Hearing impairment 6%Learning disability 6%Other disabilities 4%Health impairments 2%ADD (w/o behavior disorder) 2%

14. Boystown Study #2School based Study Public & Parochial SchoolsThe study merged almost 50,000 records from Omaha public and parochial children matriculated during the1994-95 school year with the Nebraska central registry of abuse & neglect cases, foster care review board and Omaha police records of child maltreatment.From the merger, 4,954 children were identified as maltreated, 11% in the public schools, 5% in parochial schools.

15. Boystown Study #2 Cont’d31% of the children with an identified disability had records of maltreatment in either social services or police agencies.The relative risk for maltreatment among children with disabilities was found to be three times that of other children.There was a strong association between disabilities & neglect, with children with disabilities being four times more likely to be victims than other children.Children with behavior disorders and mental disabilities were significantly more likely to be neglected.

16. Abuse & Neglect - OverviewApproximately 25% of children with disabilities acquired the disability as a result of abuse.52% of neglected children acquire a permanent disability.

17. Hey, how does abuse effect kids in later life??? • Why is this important when we are think about long term effect? Research shows that adults abused as children: • Have ongoing sequella that impact physical, psychological and social functioning • Are more likely than others to become abuse victims • Are less likely to have resources to report and recover.

18. Vulnerability is mediated by • Opportunity and Intent of the Perpetrator • Over 90% of the perpetrators are in an authorized care providing position (parent, school personnel, work or home services) • Most frequently identified are: male, • Family members, transporters, care providers • Abuses occur at home, day activity (school, work) and transportation • Lack of information & preparation of the individual and their family about this issue & what they can do to lessen vulnerability

19. Prevalence and Risk Factors (Physical, Intellectual, Sensory & Psychiatric Disabilities) • Less than 10% of abuse is ever reported • Children with Developmental Disabilities usually cannot report • Developmental Disabilities Services professionals infrequently receive training in identification & reporting of abuse • They frequently state an unawareness that abuse effects their clients • Reporting disincentives impact the agency • Most adults with Disabilities report that if they had been asked about abuse when they were children they would have told someone • Many children with Disabilities do not know or believe that an abuse-free life is an option. • For adults neglect, including medical neglect is a frequent problem, followed by sexual abuse.

20. How to Identify Abuse in Children with Disabilities • Depends upon the type of disability the child has and • Upon the type of abuse that occurred • 

21. Physical Abuse • Signs of physical abuse in Children with and without disabilities are the same. HOWEVER • Sometimes the signs of ABUSE are attributed to the DISABILITY and ignored • Sometimes the disability causes conditions that mimic signs of ABUSE and are mistaken, causing care providers to erroneously by accused of abuse. • Physical neglect (failure to provide medicine, food, water, assistive devices, etc) may cause an exacerbation of the symptoms of the disability leading to temporary mental aberration, physical symptoms, coma and even death. • Often Children do not disclose the abuse for multiple fears and no apparent sign that help is available.

22. Sexual Abuse • Physical signs of sexual abuse are the same for both Children with and without disabilities. HOWEVER, • Children with disabilities may not disclose the assault…by the time they do, all physical signs are gone (except STD’s and pregnancy of course) • Children with disabilities may not show obvious signs of distress that expose the abuse, but may have changes in mood & conduct that signal something has happened. • Children whose care provider is the perpetrator may show signs that no one sees or notices, or is attributed by the observer to causes other than assault. • Children assaulted in medical facilities (acute care hospitals for example) rarely disclose the abuse due to threats of death or other retribution by those who know their address and threaten direct harm.

23. Signs of Emotional Abuse • These are essentially the same as for Children without disabilities, HOWEVER • Verbal assaults and withholding of attention are powerful tools of abuse that are used but are “difficult to prove”, thus disclosure is delayed as the victim feels she has no “proof” of what has occurred. • Depression, withdrawal, anxiety, fears and re-enactments may be observed or suspected.

24. How can you know for sure? • ASK!!! • Most adults who have disabilities state that although they have been abused many times in their life, NO ONE ever asked about this aspect of their lives • PLEASE be sure that you have something to offer if you decide to ask this question. Such as • Time to listen to their story • Suggestions for help such as a GOOD referral to therapy, groups, books, pamphlets, videos, peer groups • Don’t just ASK then leave them in the memory of the tragedies they have survived.

25. What is the “biggest” enemy ? • Negative attitudes toward people with disabilities. • We are all products of our culture • Our culture is disability-negative • We all need to do personal work to discover then change any remaining negative attitudes sourced in myth and stereotype (sourced in fear and lack of contact)

26. Barriers to Overcome • Stereotypes blind us to seeing each person’s individual needs while perceiving some imagined “group” characteristic. Stereotype: People with Down’s Syndrome are all so loving and kind. • Myths impair our ability to understand or believe what is apparent. Myth: people with profound mental retardation are not sexual...therefore could not be sexual assault victims.

27. Attitudes, Stereotypes & Myths...lead to “Crazy Thinking” or “Not thinking” • Attitudes: Living in a “disability-negative” society, negative attitudes towards individuals with Disabilities may underlie failures to address the needs of children & adults with Disabilities that are “usual fare” for their “generic” peers. (For example, awareness that individuals with Disabilities are victimized through sexual assault and domestic violence.) • Crazy thinking occurs when a generic discussion is infused with the word “disability”, normal, rational thinking frequently goes awry...for example discussions of sexuality & normal sexual development. Physician performing a vasectomy on a teenager to preclude same sex orientation ( multidisciplinary team decision).

28. Myths and Stereotypes about People with Disabilities • Spread • Deviancy & Evil • Contagion • Innocence • Wildness • Shame

29. Cannot distinguish the truth from a lie • Cannot understand the consequences for lying • Don’t have a sufficient or correct vocabulary to describe the abuse...their communication style is suspect. • Alternative methods of communication cannot be used. • Are just plain not bright enough to be able to repeat their story • Are making up lies to get attention (…hmm why?) • Are asexual and engaging in wishful thinking

30. Preferred Language…orI don’t know the right words… • Don’t say: Say • Wheelchair bound Uses a wheelchair • Deaf & dumb Deaf & non-verbal • Mentally Retarded Slow learner • The disabled People who have x • Crippled, lame Person with mobility impairment • Wacked, loosely wrapped Person with a mental illness • Label jars not people! (People First) • Susie HAS a cold….not Susie IS a cold aka • Susie HAS mental retardation…not IS retarded • Don’t “group” folks… as in “the disabled”

31. What makes abuse different with this population? • It is a bigger “secret” • It is more extensive • Agencies often deny services • Abuse response agencies (LEA, non-profits, protective services) are not trained and do not announce that their services are for all • Disability services agencies are not yet fully “on board” in conducting outreach, information & referral or direct services

32. Children with disabilities are often completely “left out” of information processes that would give them a vocabulary to understand and describe the abuse and to know that they can get help. • Although the abuse is not significantly different than abuse and neglect with the generic population, aspects of the abuse only occur because of certain disabilities: • Withholding assistive devices • Withholding medications • Complete physical control over the child • Threats by the abuser/PCA to leave threaten the life of the victim

33. What about the Nexus of Disability and Abuse? • Domestic Violence • Head Trauma  Acquired Brain Injuries • Head Trauma  Vision Impairment/Blindness • Head Trauma  Hearing Impairment/Deafness • Head Trauma  Speech impairments • Head Trauma  Disfigurement • Other types of trauma can cause mobility impairments, injury to internal organs, etc.

34. What about the Nexus of Disability and Crime Victimization? • Crimes committed by strangers (story of Sharon D’Eusanio) • Crimes committed by acquaintances • Crimes committed against marginalized women (homeless, prostitution) (Farley, Ackerman & Banks)

35. Is there a “Culture” of Disability? • Deaf Culture • People with mental retardation • People with physical disabilities • How about separate • Languages? • Life Styles? • Being a member of an oppressed class?

36. OK…Abuse is a BIG problem for Children with Disabilities.What can we do? • Responding to Abuse • Getting Disclosures so we can provide supportive services • “Preventing” abuse • Becoming a raving advocate !!

37. Break for Part II • Where’s the cookies and milk?

38. Nora’s Nifty Nine Keys to Effective & SensitiveService Delivery to Survivors • Nothing About Us Without Us • In all Phases and Phrases • Full ADA-guided accessibility: Spirit & Letter of the Law • All staff receive disability sensitivity training • CREDO • Recognize when you don’t know & Ask when you don’t know • Website Access • Monthly meetings with Disability service agencies • Utilize CAN DO & other listservs for consultation guidance & advice. Then START implementing your plan !!!

39. 1. Nothing About Us Without Us • Include people with disabilities in • All planning for physical site changes • All planning for service delivery procedures, protocols and policies • Your Board membership • Your Advisory Board membership • All training activities

40. 2. In all Phases and Phrases • All phases of service delivery planning • All phrases of whom you serve • All phrases of whom you employ • All phrases of how you serve • All depictions of whom you serve • At all sites where you deliver service (headquarters, shelters, community trainings, Board meetings)

41. 3. Full ADA-guided accessibility: Spirit & Letter of the Law • Using your agency’s requirement to be in compliance with the Americans with Disabilities Act • Both the letter and spirit of the law • Add “serving people with disabilities” into all your PSA’s, brochures (for clients, public awareness and employment searches) • Assure comprehensive physical accessibility throughout your agency (and wherever you conduct business) • Assure comprehensive program accessibility throughout all services you provide • NOTE: Help is available if you are “not sure” from qualified ADA compliance support agencies and consultants. • Begin an ongoing campaign to conduct outreach activities in your area when you are ready to serve effectively.

42. 4. All staff receive disability sensitivity training • Prior to employment or within 6 weeks, all staff shall have completed the Disability Sensitivity & Information Training • Monthly meetings with Disability service agencies: Rotate your meetings with these agencies during the year: • CIL – Center for Independent Living • Services for people who are Deaf/Hard of Hearing • Services for the Blind/Visually Impaired + Deaf/Blind • Services for adults with Developmental Disabilities • Services for adults with mental illness • Services for adults with mobility impairments (SCI) • By rotating in this way, you will include most people with disabilities AND make good outreach by frequent contact.

43. 5. CREDO • C - Compassion • R - Respect • E - Empathy • D - Dignity • O - Open to needs of the survivor • Demonstrated in your interactions by: • Time/patience • Repetition • Understanding that their form of communication is just as valid as yours, only different. Not better, not worse. Theirs.

44. 7. Website Access • Make sure your clients have access to computers at your site that are • Bobby Approved • Accessible for people with disabilities • Make sure your site is Bobby Approved! • Join listservs to stay up to date & get help • Participate in on-line learning experiences, especially the Arc-Riverside First Professional Online Conference on Abuse and Disability. • And, participate in the Arc Riverside National/International Conference on Abuse & Disability each year in March.

45. 8. Monthly CAN DO™ meetings with Disability service agencies • Collaborative meetings with all agencies in your area that provide services to crime victims on a regular basis will • Ensure a better response • Educate generic service providers • Continue to make others aware of crime victims with disabilities by mentioning it at each meeting. • Conduct cross trainings between CJS/DV and disability service providers • CAN DO is Arc Riverside’s Model Program for improving response to crime victims with disabilities: These multiagency monthly meetings are modeled on the SCAN teams in child abuse. • CAN DO = Collaborating on Abuse & Neglect: Disability Outreach. We can help you become a Certified CAN DO Community

46. 9. Utilize CAN DO & other listservs for consultation guidance & advice. • Stay connected with others to both give and get information & support • Learn about new materials as soon as they are available: videos, curricula, training programs, conferences, etc. Share materials you’ve found. • Learn about “tried and true” materials (“Nora ad”) for stuff I’ve written, stuff I’ve collected. (Blue/brown/green/pink) • Ask your questions, get immediate responses from others who share your experiences.

47. START • Begin work on the plan you have developed with your Board and Advisory Board. • Develop a time line. Reward yourself for all steps no matter how large or small. • If you don’t start now, you won’t. • “No one ever achieved success through the practice of procrastination”. • Develop a “baseline” from which you can measure your success and achievements.

48. Do’s & Don’ts • Use preferred language both in and out of earshot of individuals with disabilities, and in writing. • Talk to the survivor not about her with others in her presence • Don’t touch! • Don’t talk down or infantalize • Don’t touch the wheelchair • Explain what you are about to do • Use Plain English! • Don’t talk to the interpreter, talk to the survivor!

49. Quality Service • Make sure your staff is TRAINED to provide effective and sensitive services to clients with disabilities… not “any willing provider” aka “warm body” will do. • Use certified staff where certifications are required • Conduct client evaluation surveys for self-assessment and service improvement guide.

50. Getting Disclosures so we can provide supportive services • Using Abuse Screening Tools • What is the purpose of asking? Know this for your agency and for your self. • What supportive services can you immediately offer? Know your referrals, make the appointment for the client. This helps keep up with changing phone numbers & agency availability…as well as relieves the client of added burdens. • What linkages do you have with the community to assure access to supportive services (availability, transportation, confidentiality, accessibility, trained personnel)? • Issues of mandatory reporting • Care not to interview when that interview may “ruin” the case for legal prosecution.