An Overview of Violence Against Children with Disabilities 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 BEST PRACTICE II CONFERENCE 2004 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 means 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 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. 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) 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. 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 Disabilities 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, Sullivan • 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 disability. 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 maltreatment. From the merger, 4,954 children were identified as maltreated, 11% in the public schools, 5% in parochial schools. Boystown Study #2 Cont’d 31% 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. 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 victims • Are less likely to have resources to report and recover. 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 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 harm. 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 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 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) 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 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). Myths and Stereotypes about People with Disabilities • • • • • • Spread Deviancy & Evil Contagion Innocence Wildness Shame • 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 Preferred Language…or I don’t know the right words… • Don’t say: – – – – – 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 impairment 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 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 • 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 1. 2. 3. 4. 5. 6. 7. 8. 9. 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 !!! 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 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. 4. All staff receive disability sensitivity training 1. 2. 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: 1. 2. 3. 4. 5. 6. 3. 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. 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. 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 abuse. • CAN DO = Collaborating on Abuse & Neglect: Disability Outreach. We can help you become a Certified CAN DO Community 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. 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. 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! 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 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 problem – Tertiary – Providing intervention services to those who have experienced the problem Responding & Investigating • The DCFS or APS hotline receive reports of suspected abuse. • The police or sheriff in a locality may receive the initial report • 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 & Prosecution • 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 st 1 Response • 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 available • 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 preparation • 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 As 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 Project • Contact Arc Riverside • Visit the CAN DO website: www.disabilityabuse.com/cando • 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 Disabilities 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 Nora@disability-abuse.com www.disability-abuse.com/cando First Online Professional Conference on Abuse & Disability • 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. • REGISTER TODAY: • WWW.DISABILITY-ABUSE.COM The End! • Please stay in touch !!! • By visiting www.disability-abuse.com/cando • By email: firstname.lastname@example.org 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 – www.ncjrs.org People with Developmental Disabilities: Abuse & Crime Victimization How to Help Nora J. Baladerian, Ph.D., LMFT CST, ACFE, C.Hyp. EP Abuse & Disability Projects Director CAN DO: “Child Abuse & Neglect Disability Outreach Project” Arc Riverside, California Jim Stream, Executive Director & Project Director 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 Disabilities • Defines Abuse • Lists signs and symptoms • Outlines “what to do after” options & resources • Describes impact of abuse on the person & the family • Describes how to plan for this contingency. Defining Abuse and Neglect Sexual Physical Emotional/verbal Severe Neglect Financial 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 nomenclature: – 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 that: • “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 disabilities.) Which leads to creating innovative responses to normal work activities • Pointing to ones self to illustrate abuse or body parts • Investigators interview all in the home/family except the victim • Using “baby talk” with adults with cognitive impairments • Agree to place young man in an institution for normal affection with a child Boystown Study And Other Significant Contributions to the field can be found at www.nap.edu 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 evidence). >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, roommates Usually males (by report) who have a close family relationship Often the perpetrator lives with or has careprovider responsibilities & authority Further, 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 disability. 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 Effective Non-Effective Consistent with strengths & beliefs of individual Focus on person’s real life factors (family, transportation, health, communication skills) Based on concrete instructions and tasks 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 concepts Body Integrity is assumed. 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 awareness 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: reasonable do-able Environmentally sound individualized culturally responsive practiced 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 intuition >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 assertion >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: >immediate >calming >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 Disabilities 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 LEARNING MODALITIES The most powerful learning modalities are suggested. These are in descending order example, experience and explanation. 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. LEARNING STYLES In addition, each individual has a preferred learning style, be it visual, auditory or kinesthetic. 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, phobias Depression and sadness Irritability, anger Withdrawal 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). Resources Subscribe to newsletters and journals that provide relevant information Join NADD, AAMR, and other professional organizations Attend conferences for people with disabilities And..... 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@example.com 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!! www.disability-abuse.com/cando/conf Everything from the Conference is still available to you except being there! -> DVD with Conference Highlights • 67 minutes of information-packed presentations • 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 Conference!!! First Online Professional Conference on Abuse & Disability • 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. • REGISTER TODAY: WWW.DISABILITYABUSE.COM Plan to attend our National – 3rd International Conference at the Riverside Convention Center March 14-16, 2005 by Arc Riverside in Riverside, California (Near Palm Springs) th 10 Get more information... www.disability-abuse.com We say, “www dot disability minus abuse dot com” !!! To help take “abuse” out of the lives of those with disabilities!! Where you can Register Get Call for Papers & Submit your proposal Get the Hotel Registration information Get more information as the Conferences develop Get information on how to become a Sponsor Get information on how to volunteer to help... JOIN OUR PROFESSIONAL NETWORK 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!!