An Overview of Violence
Against Children with
Presented by: Nora J. Baladerian, Ph.D., CST, BCFE
Disability, Abuse & Personal Rights Project &
CAN DO! Project of Arc Riverside
Child Abuse & Neglect Disability Outreach
for the
On Child Abuse & Neglect
Mobile & Birmingham, Alabama
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
– Accidents
- Longer life spans
- Improved medical care
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
What kinds of disabilities are
– The 5 senses: hearing, vision, touch, taste, smell (NOTE: The 6th sense
does not seem to be impacted by the disability!! Interesting, eh?)
Mobility Impairment
Social (Characterological or Autism Spectrum)
Psychiatric (Bio-Medical, thought disorders)
Medical including Neurological, Endocrine, etc.
Hey, What about Developmental
• “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.
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,
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
• Have equal vulnerability as children with disabilities
(Baladerian,, 2001 [anecdotal]) (Why would it be different,
since vulnerability transcends age categories)
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,
• Approximately 2 million elders per year have
substantiated abuse cases.
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
Overview of Abuse & People with
Children with disabilities are abused
more than generic kids by a factor of
• 1.7 DHHS/NCCAN, 1991,Westat
• 3.4 Boystown Research Hospital, 2000,
• 7 Compilation of smaller studies from
1982 to date
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.
Among the 15% maltreated,
64% had a disability,
Of the nonmaltreated 32% had a
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%
Boystown Study #2
School based Study Public & Parochial Schools
The 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
From the merger, 4,954 children were identified as
maltreated, 11% in the public schools, 5% in parochial
Boystown Study #2 Cont’d
31% of the children with an identified disability had
records of maltreatment in either social services or police
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.
Abuse & Neglect - Overview
Approximately 25% of children with
disabilities acquired the disability as
a result of abuse.
52% of neglected children acquire a
permanent disability.
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
• Are less likely to have resources to report and
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
• Lack of information & preparation of the individual and
their family about this issue & what they can do to lessen
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.
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
• 
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.
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
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
• Depression, withdrawal, anxiety, fears and reenactments may be observed or suspected.
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.
What is the “biggest” enemy ?
• Negative attitudes toward people with
• 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)
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.
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
• 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).
Myths and Stereotypes about People
with Disabilities
Deviancy & Evil
• 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
• Are asexual and engaging in wishful thinking
Preferred Language…or
I don’t know the right words…
• Don’t say:
Wheelchair bound
Deaf & dumb
Mentally Retarded
The disabled
Crippled, lame
– Wacked, loosely wrapped
Uses a wheelchair
Deaf & non-verbal
Slow learner
People who have x
Person with mobility
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”
What makes abuse different with this
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
• 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
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.
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)
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?
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 !!
Break for Part II
• Where’s the cookies and milk?
Nora’s Nifty Nine Keys to
Effective & Sensitive
Service 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
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 &
Then START implementing your plan !!!
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
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)
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
– 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.
4. All staff receive disability sensitivity
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.
C - Compassion
R - Respect
E - Empathy
D - Dignity
O - Open to needs of the survivor
•Demonstrated in your interactions by:
• Understanding that their form of communication is just
as valid as yours, only different. Not better, not worse.
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.
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
• CAN DO = Collaborating on Abuse & Neglect: Disability
Outreach. We can help you become a Certified CAN DO
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.
• Ask your questions, get immediate responses from
others who share your experiences.
• 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.
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
• 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!
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
• Conduct client evaluation surveys for selfassessment and service improvement guide.
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.
Preventing abuse
• Understanding public health concepts:
– Primary – Educating everyone about a problem
– Secondary – Educating those likely to have the
– Tertiary – Providing intervention
services to those who have experienced
the problem
Responding & Investigating
• The DCFS or APS hotline receive reports of suspected
• The police or sheriff in a locality may receive the initial
• They SHOULD/COULD ask if the individual has a
disability...this would
• Prepare the individual who will respond to the report to use
“disability-specific” protocols & call for assistance as
needed, for example Sign Language interpreters.
• Assist in the development of a data base of “reported
cases” referred for first response & screening
Interviewing, Intervention &
• The first responder should interview the victim & others
present, determine “next step” for the case
• Interview SHOULD follow normal legal protocols +
accommodations for the disability of the victim
• Prosecutors SHOULD be trained in issues of disability to
address concerns such as witness credibility
• Intervention SHOULD involve a multidisciplinary team
providing specialized information & resources for both the
victim/family & the team.
Next Steps AFTER
• Contacting the Victim’s Assistance Advocates
office to facilitate first contact for the survivor,
and advising them to assure that an interpreter or
other needed accommodation will be readily
• Identify the needs the survivor wants to address
first, provide for those needs
• Where necessary, advocate for the survivor’s
access to generic and specialized services.
Assuring Proper Treatment for Victims
of Violence with Disabilities
• ADA Requires Accommodation to the (mental health )Patient’s disability
• Mental health treatment for sexual assault victims with cognitive Disabilities or
developmental Disabilities (autism, mental retardation) requires that the
specialist providing (child) abuse or sexual assault treatment also be trained
and skilled in working with people with Disabilities
• The treatment may require many sessions over time, shorter sessions, adaptive
equipment and Certified Interpreters unless the therapist is fluent in the signing
or other communication method used by the patient
• The treatment will require involvement with the family (as secondary victims)
& to reinforce the treatment
• The team will need to collaborate with others in the community with whom the
patient is or should be involved
• Understanding that trauma will not express itself in the same way in people
with some Disabilities...this does not mean no trauma has been felt.
Issues that have arisen:
• The myth of “informed consent” for sex, rather than intervention for nonconsensual sex.
• The withholding of sexual rights for people with Developmental Disabilities
• A false belief that Sex education does not require formal teaching
• This is a BIG area of concern, which is why there are certification
programs. One should be CERTIFIED to teach any subject, particularly one
fraught with such controversy, misinformation, disinformation, and
entwined in morality, ethics and law. One can become CERTIFIED as a
sex educator, sex counselor or sex therapist. Allowing non-certified
individuals to teach is yet another demonstration of the lack of value given
to individuals with Disabilities
• Sex Education is not the same as sexual assault awareness. Nor is sex
education clinical psychotherapy OR sexual assault or trauma treatment.
• Using abuse awareness programs that address stranger danger is a gross
misuse of time and money since 99% of the problem is missed.
• A frequent response to sexual assault is to provide
sex education. Thus, Nora’s Maxim:
Sex Education
Is to
Sexual Assault
Budgeting Training
Is to
Armed Robbery
Over time, perpetrators have offered a
variety of reasons for the sexual contact
or denying the sexual contact:
She came on to ME!
It was consensual
I was teaching her/him about sex
I don’t have a penis
Or their colleagues, in one case....
She’s a nympho AND he is a GREAT guy
How to find qualified consultants?
• Contact the Disability, Abuse & Personal Rights
• Contact Arc Riverside
• Visit the CAN DO website:
• Contact the disability service agency in your area
(ILC or the State or National ILC association)
• Contact NADD for suggestions in your area
• Contact the UAP/UCE in your area
9th National/2nd International Conference
on Abuse of Children & Adults with
March 2003
• Conference Highlights DVD
67 Minutes of the “Best” of the Best
Available from Arc Riverside
Just visit the Website for ordering information
Also view the entire program, order
• Videotapes of selected presentations
• Audiotapes of selected presentations
Purchase by contacting Arc Riverside:
Phone: 1 909 688 5141 FAX: 909 688 7207
[email protected]
First Online Professional
Conference on Abuse &
• WHEN: September 9-30, 2004
• WHERE: At your computer!!!
• WHAT: 22 seminars by top nationally recognized
experts teaching:
• Identification & Reporting - First Response Investigation - Interviewing - Prosecuting Judge’s Role - Victim Services - Psychotherapy
• AND: Communication - Legislation - Policy
…From YOUR computer!!
• HOW MUCH: $150 full tuition, includes CEU’s . No
“late registration” fees. Limited Scholarships.
• Advantages: You can attend on your own schedule
(time shifting)…no travel, parking, child care, time off
work. You can repeat viewing of all seminars. All
faculty offer up to 9 hours post conference consultation
with registered students.
The End!
• Please stay in touch !!!
• By visiting
• By email: [email protected]
CAN Do! Project
2100 Sawtelle Blvd. #303
Los Angeles, CA 90025
310 473 6768 (Office)
310 996 5585 (Fax)
OVC Video
• The Time is Now
• Meet us Where We Are
• Available at no charge from the Office for
Victims of Crime:
• OVC Resource Center: 1 800 627 6872
– TDD: 1 877 712 9279
People with
Developmental Disabilities:
Crime Victimization How to Help
Nora J. Baladerian, Ph.D., LMFT
Abuse & Disability Projects Director
CAN DO: “Child Abuse & Neglect
Disability Outreach Project”
Arc Riverside, California
Jim Stream, Executive Director & Project
Purpose for the Training
Describe abuse & neglect.
Present research on incidence
Present practices for risk reduction
Describe the effect of maltreatment
upon individuals with disabilities
and their families.
Knowledge is Power !!
Use the “Pink Book” as your guide.
• A Risk Reduction Guidebook on Abuse to Use for
Children & Adults with Developmental
• Defines Abuse
• Lists signs and symptoms
• Outlines “what to do after” options & resources
• Describes impact of abuse on the person & the
• Describes how to plan for this contingency.
Defining Abuse and Neglect
Severe Neglect
Identifying laws related to abuse
and reporting responsibility:
Child abuse laws
Dependent or vulnerable adult
•Major Issues in Disability
1. The Biggest Disability
is negative attitudes towards people
with disabilities
2. Myths & Stereotypes
3. Language
4. Crazy thinking
Principle Negative Attitudes
• Devaluing
• Demeaning
• Distancing
Myths & Stereotypes
• These include beliefs that undermine the full
personhood of someone due to their disability, such
as credibility, or the validity of their disclosures.
• This includes the “difficulty” aka denial that some
experience believing that anyone would sexually
assault someone with a disability.
• Another myth is the belief that all persons with
Down Syndrome are loving wonderful people, that
they are all innocent (asexual).
• Finally, fears that people with disabilities are either
sex maniacs or asexual.
Language Concepts
• Using language that enhances rather than language that hurts,
demeans or dehumanizes requires listening to those who tell us the
words & phrases they like.
• The People First proclaims “label jars, not people”, and encourages
referring to the disability only when necessary to a conversation.
• Do not use euphemisms such as the words (mentally) challenged,
• Or words that group (THE disabled).
• First refer to the PERSON, then the disability if necessary…. “Let’s
talk about Susan, the woman who has Down Syndrome”.
• Understand that people HAVE disabilities, not ARE disabilities…. As
in, “Suzy HAS a cold”, not “Suzy IS a cold”.
Some things to say….and to avoid
Deaf & dumb person who is deaf & non-verbal
Retarded –> has mental retardation or an intellectual impairment
Wheelchair bound – person who uses a wheelchair
Autistic – has autism
Visually challenged - blind
Cue: STAY TUNED! Language preference change and grow. So does disability
– Out: TBI – Traumatic Brain Injury
– In: ABI – Acquired Brain Injury (reason: to include those who have acquired
brain injuries through stroke & other medical conditions but require identical
treatment & resources.
– Out: Challenged/Differently Abled
– In: Person who has “x” disability
• Your desire to be respectful and treat others with dignity while we
learn and change makes all the difference.
• Take care with casual talk “that is so retarded!”…”look at that
spaz”…from “teen talk” such as Beavis & Butthead.
Crazy Thinking
Sanity leaves when you say... “disability”.
For example, some have erroneously stated
• “All people with Down Syndrome, in their young
adulthood, begin to exhibit abnormal sexualized conduct,
depression, irritability, anxiety & PTSD.” (misattribution
of signs of abuse)
• “People with autism do not have feelings, thus cannot be
injured psychologically.” (De humanizing individuals with
Which leads to creating
innovative responses to normal
work activities
• Pointing to ones self to illustrate abuse or body
• Investigators interview all in the home/family
except the victim
• Using “baby talk” with adults with cognitive
• Agree to place young man in an institution for
normal affection with a child
Boystown Study
Other Significant Contributions to
the field can be found at
Click on Article on Crime
Victims with Disabilities
Abuse & Neglect - Abusers
It is estimated that in 98% of cases of
sexual abuse, the perpetrator is well
known to, trusted by, and in a care
providing position to the victim.
Perpetrators seek people with
disabilities as they are less likely to be
caught or be convicted.
Abuse & Neglect – Victims
“Cascade of Barriers to Helping”
Most victims do not tell anyone about
the abuse.
• Most are not asked about abuse
• If they tell, there is rarely help given
• If a report is taken, most likely it will not be
effectively investigated (interview, external
>If a report is filed, prosecutor is
less likely to accept it;
>If case is tried, case is less likely
to result in a conviction;
>If a conviction, a short or reduced sentence is most
likely; &
>Rarely referred for psychotherapy regardless of
legal case outcome and process.
>If referred for psychotherapy, most likely to receive
treatment from a student untrained in working
with folks with disabilities.
How can the number of maltreatment
incidents be reduced?
We can focus our efforts upon the victims
to “be responsible” OR
We can focus on care giving
conduct that can reduce the number
of abuses against children & adults
with disabilities that is thoughtfully
considered, based upon simple
rational steps efforts.
First, in studying the research we find that in
about 99% of cases, the perpetrator is well known
to the victim, either as a
Family member or close family friend
Fathers, grandfathers, uncles, domestic partners,
Usually males (by report) who have a close family
Often the perpetrator lives with or has
careprovider responsibilities & authority
Often the perpetrator is well liked by others & the abuse is
hard to believe
And has an authorized position with the child/adult victim
Special Education teachers or teacher aides, or other
professional role
Work supervisors, counselors, staff & administration
Allied health professional such as Physical Therapist,
Occupational Therapist
Supportive staff such as transporters (bus drivers, driver aides)
Authorized respite care or residential care provider or assistant
With this knowledge, we can, as the adults
(professional or parent), institute very
effective protections to reduce the
incidence of abuse
Ideas would include
1. Improved employment practices
including thorough employment history
verifications and background checks
PRIOR to beginning employment
2. Requiring training qualifications for the position
(no waivers) (approximately 60% of current Special
Education teachers in California do not have a
credential but are on waivers).
3. Requiring that Individual Education or Program
Plans be adhered to, particularly when potential
danger has been identified and a protection
established. Same for Individual Program Plans and
Individual Habilitation Plans.
4. Using teams of at least two persons to be
present when a single child or adult is being
treated, educated or assisted
5. Using a system of rotation of individuals in
charge of children and adults.
6. Increasing the pay and qualifications for those
entrusted with child care and adult care
7. Providing abuse recognition & reporting
training at schools and other locations where
mandated reporters work
8. Establishing “reporting supportive”
atmospheres in agencies, schools, and other
organizations where children & adults with
disabilities are.
Nora’s personal belief:
Increasing personal safety, and accelerating
reporting (as soon as possible after the assault)
is the responsibility of the adults in the
individual’s life, not the individual with a
There is no characteristic that a person can
develop that will guarantee freedom from abuse,
regardless of a disability.
Assertions skills, body language, or self
defense may not be effective when the
perpetrator is one’s own family member,
supervisor, coach or transporter. This
holds true for both children and adults.
3 Critical Factors for an Effective
Risk Reduction Plan
• It uses the strengths of the child/adult with
a disability
• It is wholeheartedly adopted by the
individual and his/her family
• It is practiced regularly within the family
setting along with other safety plans
(earthquake, etc.)
Effective vs. Non-Effective Risk Reduction Plans
Consistent with strengths &
beliefs of individual
Focus on person’s real life factors
(family, transportation, health,
communication skills)
Based on concrete instructions and
Wanted v not wanted is taught
rather than good/bad “touch”
Focus is on those with whom the
person & family is familiar.
Violates Social Rules
General rules such as
“no, go, tell”
Based on abstract
Body Integrity is
Focus is on strangers
How can
The impact upon the abuse victim
be ameliorated?
PODER "Poder" means
"Power" in Spanish
Using the Individualized Response
Plan (IRP)
Power through information and
Information about abuse should be:
Family Based
Culturally relevant
Environmentally presented
in a non-threatening way
using clear statements
using concrete images and examples
in Plain English/French/Spanish
Overt responses to possible abuse
taught that make sense
Techniques children & adults can use if
abuse occurs should be:
Environmentally sound
culturally responsive
Determination of potential danger
In order to avoid, recognize and
acknowledge possible abusive situations,
there needs to be a basis for distinguishing
abuse from accident, volition from error, and
a forum in which to talk about these
distinctions in which free flow discussion
allows the child to learn to form ideas and
trust her/his own judgment. Therefore it is
best when possibly abusive situations are
examined that...
>ideas and questions are respected
>questioning is based in reason or
>together with friends or care providers
who are trusted
>through frank and everyday type
family discussions, and
>include the possibility of identifying
abuse that is past or current
Effective Preparedness
Skills and knowledge that are used
frequently can be called upon almost
automatically when needed. The
most powerful reactions to
emergencies are those that have been
practiced repeatedly and employ
skills used regularly. The following
are those skills that fit these criteria:
trust of the sixth sense
self knowledge
verbal self defense
physical self defense
>trust of the sixth sense
>awareness of one's surroundings
>familiarity with persons in one's
immediate vicinity
>self-respect (demonstrated from
and to one's self)
Response to abuse is expected and
effective and is:
>exactly what had been explained and practiced
>reduces the emotional impact of the abuse
>calls upon a pre-identified support system
>results in effective intervention for primary and
secondary victim
The Objective Is to Reduce the
Incidence and Impact of Abuse and
Neglect of Children & Adults with
PODER presumes unequal abilities among children
and youth, a wide variety of personalities, cultural and
ethnic heritages, a wide variety of community and
national cultural rules and boundaries.
PODER presumes that there are a variety of family or
living situations in which one might reside, and a
variety of family relationships for the child or youth
with a disability
The most powerful learning modalities are
suggested. These are in descending order
experience and
The material to be taught regarding abuse in general
includes learning what abuse is, learning how to
recognize it, learning how to react if abuse is
attempted or completed, and learning what to do
when abuse occurs.
In addition, each individual has a preferred learning style,
be it
auditory or
The schools use a "multi modal" approach, using all
three to teach their material. It is equally important to do
this when teaching this critical information on self care.
Using books or pamphlets with drawings, doing drawings
or using puppets or role plays, as well as hearing and
saying practiced responses is very effective.
Through the use of PODER as an overlay to your
curriculum for reducing the risk of abuse or
reducing the emotional impact of abuse, you can
expect success.
The individualized approach combined with a realistic
appraisal of the individual’s environment, abilities and
cultural aspects work together to assure success. The
program works when all concerned are in agreement
with the plan and continue to rehearse the response to
an assault regularly, so that if it should be needed, the
ability to use the planned response is present.
Effects of Abuse
Fears such as social anxiety, generalized anxiety,
Depression and sadness
Irritability, anger
Trouble thinking, concentrating, remembering
Re-enactment & somatization
Change in normal behavior & personality
Self injury
Sleep disturbances
Post Traumatic Stress Disorder
New Disabilities either psychiatric,
physical, sensory, or other.
Family Impact: Secondary Victims
include family members (including
residential care providers).
Subscribe to newsletters and journals
that provide relevant information
Join NADD, AAMR, and other
professional organizations
Attend conferences for people with
Acquire books, articles of relevance and interest from
Nora & others
1. “Guidebook on Abuse & Individuals with Cognitive
and/or Communication Impairments” (The “Pink Book”)
2. “Sexual Assault Survivor’s Guidebook for People with
Developmental Disabilities” (The “Blue Book”)
3. Treatment Guidelines for Abuse Victims with
Disabilities (The Yellow Book)
4. FACTS: Forensic Assessment of Consent to Sex
5.Counseling People with Developmental Disabilities who
have been Sexually Abused (NADD, Shiela Mansell, PhD.)
6. Treating Rape Victims with Developmental Disabilities
(NADD, Ruth Ryan, M.D.)
Join with Arc Riverside’s CAN
DO Project …
• This project develops improvements in local and
Statewide responses to abuse of children with
disabilities through:
Improvement of statewide data collection activities
Development of multidisciplinary team approaches
Provision of training programs for responders
Collection & dissemination of resource information
On Line Consultation “among the experts” on CAN DO
listserve: [email protected]
You can help…
• Volunteer with the CAN DO Project
• Work with the CAN DO Project to make your local community
eligible to become a Certified “CAN DO Community”.
Contact us for eligibility criteria
• Becoming informed about these issues and conducting public
awareness or technical training or consultation programs
• Distribute information about the CAN DO Project at your
associations and other membership organizations
• Work with us on the next National Conference
March 2003
9th National - 2nd International
Conference On Abuse of
Children and Adults with Disabilities
Together We CAN DO it!!
Everything from the Conference is still available to
you except being there! ->
DVD with Conference Highlights
• 67 minutes of information-packed
• Includes heart warming Keynote by Victor
Rivers, NNEDV spokesperson
• Can be utilized for in-service training
• Can also be used for general trainings
• Great to select speakers for your
First Online Professional
Conference on Abuse &
• WHEN: September 9-30, 2004
• WHERE: At your computer!!!
• WHAT: 22 seminars by top nationally recognized
experts teaching:
• Identification & Reporting - First Response Investigation - Interviewing - Prosecuting Judge’s Role - Victim Services - Psychotherapy
• AND: Communication - Legislation - Policy
Online Conference
• HOW MUCH: $150 full tuition, includes CEU’s .
No “late registration” fees.
• Advantages: You can attend on your own schedule
(time shifting)…no travel, parking, child care, time
off work. You can repeat viewing of all seminars.
All faculty offer up to 9 hours post conference
consultation with registered students.
Plan to attend our
National –
3rd International Conference at the
Riverside Convention Center
March 14-16, 2005
by Arc Riverside
Riverside, California
(Near Palm Springs)
Get more information...
We say,
“www dot disability minus
abuse dot com” !!!
To help take “abuse” out of
the lives of those with
Where you can
Get Call for Papers & Submit your proposal
Get the Hotel Registration information
Get more information as the Conferences
Get information on how to become a Sponsor
Get information on how to volunteer to help...
Join with hundreds of others from
around the world to share information,
successes and failures (aka learning
experiences !!) by becoming a member
of our CAN DO Listserv.
Just go to our website, and click to join
us. We need you!
The End!
Thank you for coming!!