Responding to Violence Against People with Disabilities

Have you ever....

Why are we here today?  How comfortable are you with… understanding dynamics of domestic violence, sexual assault, caregiver abuse? understanding dynamics of domestic violence, sexual assault, caregiver abuse? responding to a disclosure of abuse? responding to a disclosure of abuse? knowing the community resources available? knowing the community resources available? recognizing risk factors and warning signs for a person with a disability? recognizing risk factors and warning signs for a person with a disability?

 Children with disabilities are twice as likely to be physically and sexually abused (Abramson, Emanuel, Gaylord, & Hayden, 2000). Child abuse may also result in disabilities. American Academy of Pediatrics, 2007

 Individuals with disabilities also experience more intense abuse for a longer period of time. Women with disabilities experience multiple incidents with multiple perpetrators. Young, Nosek, Howland, Chanpong & Rintala, 1997; Nosek, Hughes, Taylor & Howland, 2004; Nosek, Howland, Rintala, Young, & Chanpong, 2001

 One study found that more than 70% of women with developmental disabilities had been sexually assaulted, and 50% had been sexually assaulted ten or more times Sobsey and Doe, 1991

 People with disabilities are abused in all settings. Forty percent of nurses and aids in intermediate care facilities admit to psychologically abusing clients Pillemar & Moore, 1990

  Hospitals, doctors’ offices, special education classrooms, specialized transportation services and other disability-related settings may create a restrictive environment by separating children and adults from their assistive devices, and restraining them or isolating them from others who could provide assistance, which diminishes their ability to defend themselves Nosek, Howland & Hughes, 1999

 Children and adults with disabilities have among the highest rates of physical, emotional and sexual abuse compared to any other group in our society today. Abramson, Emanuel, Gaylord, & Hayden, 2000

Crimes Against People with Disabilities  Rate of Nonfatal violent crime against persons w/ disabilities was 1.5 times higher than the rate for persons w/o disabilities  Rape or sexual assault was 2 times higher  Females with disabilities had higher rate than males with disabilities  Males with disabilities had higher rate than females without a disability  Persons with cognitive disabilities higher rate than people with any other type of disability  Half of all nonfatal violent crimes against people with disabilities were perpetrated against people with multiple disabilities Bureau of Justice Statistics, 2007 Bureau of Justice Statistics, 2007

Credo for Support Video

“Listen, don’t judge or re-victimize.” - Focus Group Participant

Types of Abuse  Domestic Violence (DV)  Sexual Assault (SA)  Caregiver Abuse

Domestic violence or battering:  A pattern of physical abuse, intimidation, coercion and other forms of abuse committed by a person to establish or maintain control over his or her partner.

Sexual Assault Any sexual act where active consent is not given by both parties. This includes (and is not limited to): Rape of any kind Rape of any kind Sexual photographs Sexual photographs Groping/grabbing Groping/grabbing Sexting Sexting Facebook/internet activity Facebook/internet activity

 What is consent?  Who are perpetrators?  What are common red flags?

Caregiver Abuse The misuse of power in the caregiving relationship, where persons who have disabilities may depend upon caregiver(s) in order to function independently. Types of Caregiver Abuse: Physical Sexual Emotional/Verbal Physical Sexual Emotional/Verbal Financial Neglect

Overprotection  Advocate and Educator David Hinsburger calls overprotection of people with disabilities “the Other Abuse.”

“Understand that caregivers can abuse and agencies may protect them.” - Focus Group Participant

C ontributing Factors to Increased Vulnerability and Victimization of People with Disabilities  Increased dependency on others for long term care  Denial of human rights  Perceived lack of credibility perceptions of powerlessness perceptions of powerlessness

Contributing Factors to Increased Vulnerability and Victimization of People with Disabilities  Less education about sex and what is appropriate and inappropriate  Social isolation and increased risk of manipulation  Physical helplessness and vulnerability in public places  Integration without consideration of self- protection (Myers, 1999)

Similarities and Differences in Domestic Violence for People with and without Disabilities

Similarities  Violence of any kind, by someone known to the victim, usually gets worse over time unless there is effective intervention.  Domestic violence often begins with seemingly minor forms of emotional abuse.  Abusers use the forms of control already discussed against victims with and without disabilities.

Differences  Victims with disabilities may take longer to decide to leave.  Victims with disabilities may only leave once and it is usually permanent.  Victims with disabilities may depend on their abusers for food, medications, access to finances, personal care necessary for survival.  Twice as many men with disabilities as men without disabilities experience abuse.

 Victims with disabilities may be threatened with more restrictions to their independence when they try to leave.  Leaving may be complicated by lack of accessible housing and/or transportation.

Double Birdcage Activity Volunteers?

“Believe us, take us seriously.” - Focus Group Participant

Disclosures  Indirect Emotional or behavioral changes noticed Emotional or behavioral changes noticed  Involuntary Obtained from medical records or case notes Obtained from medical records or case notes  Direct and Voluntary Response to intake or interview questions by choice Response to intake or interview questions by choice

At the time of disclosure, survivors need…  to feel safe  to be believed  time and space  Information and resources  choice  honesty

“Take the time to make sure the person with a disability can understand and communicate back.” - Focus Group Participant

Disability, Violence and Survival: A Personal Story

Discussion

Red Flags and Indicators of Abuse

“Realize it takes a long time to build trust.” - Focus Group Participant

Considerations…

Considerations for Confidentiality  Minnesota Data Practices Act  Minnesota Medical Records Act  Health Insurance Portability and Accountability Act (HIPAA)  A consent form or authorization to release information form

Mandatory Reporting  Who is a Mandated Reporter?  Who is a Vulnerable Adult?  What must be reported? Abuse Abuse Neglect Neglect Financial Exploitation Financial Exploitation Minn. Stat Minn. Stat

Barriers to Reporting an Abusive Caregiver:  Agency assumption that caregiver "problems" are improper management by people with disabilities  Label as "difficult client"  Abuse may be hard to document and prosecute  So intimidated people with disabilities will not reveal real reason for dismissal  no emergency PCA provider; could end up with no caregiver  Possibility of retaliation  DV shelter services may not "fit" unless caregiver is a relative

Barriers to Leaving an Abusive Relationship:  Isolation  Financial dependence  Nowhere to go  Fear  Children  Increased threats  Lack of Support  Belief  Abuser will take advantage of the disability  Leaving takes more advance planning  May need new PCA  Fear of becoming dependent on institutional care  Perceived as ineffective parents  Accessible housing Additional barriers for individuals with a disability:

SAFETY PLANNING: Individualized Process to identify risks, routines, resources and strategies that increase safety. Individualized Process to identify risks, routines, resources and strategies that increase safety.

Cautions about Safety Plans!  Can be dangerous if abuser finds the plan  Should not be developed without specialized training  Know when and where to make a referral for safety planning!  Know when and where to make a referral for safety planning!

Safety Planning for People with Disabilities  Individualize for the situation  Use simplified language with a person with a cognitive disability  Engage the individual in the planning process  Respect his/her thoughts and decisions  Assure confidentiality and safety at all times  Meet in a safe and private location  Allow for breaks or several meetings  Involve a support person if necessary to help remember steps and actions

How to help an individual with a Safety Plan Four Key Steps: 1. Assess the victim's personal situation 2. Use that info to individualize planning strategies 3. Determine what your agency can do 4. Re-evaluate the situation and answer questions

“Know the resources available for people.” - Focus Group Participant

Local Collaborative

Statewide Resources

Moving Ahead  How confident are you that…… you can sensitively support a person with a disability who discloses abuse? you can sensitively support a person with a disability who discloses abuse? your agency can effectively provide education and training to your own staff on topics related to domestic, sexual, and caregiver violence against people with disabilities? your agency can effectively provide education and training to your own staff on topics related to domestic, sexual, and caregiver violence against people with disabilities? your agency can connect and collaborate with other agencies to provide services and support for people with disabilities who have experienced violence or abuse or who are at risk for abuse? your agency can connect and collaborate with other agencies to provide services and support for people with disabilities who have experienced violence or abuse or who are at risk for abuse?

Closing Questions or Comments ?

Contact Information Laura Birnbaum, Advocacy & Grant Coordinator Arc Northland or Arc Northland or Erin Fontaine, IL Specialist / Trainer Access North x208 or Access North x208 or Susan Terry, Advocate / Criminal Justice Liaison PAVSA x23 or