Addressing Sexual Violence Against Individuals with Disabilities
Heather Kamper  -  2009/7/22
http://ovc.ncjrs.gov/ovcproviderforum
 
 
We had a report recently of an older, disabled woman in an adult care facility being raped by a male resident in the home. Police did not charge the alleged perpetrator, because of his diminished capacity and hers. How does this response protect the next potential victim(s), and how many other victims might there be? (He was simply moved to another group home, will all male residents.)
 
1.  Heather
 Its true that simply moving the alleged perpetrator is not going to reduce the risk of further victimization - it just makes the men who live with the alleged perpetrator to be at an increased risk of violence. We can't possibly know how many other victims there are - but what we can do is focus on providing support to the survivors and to those who are at risk. Things we can do: Provide education to staff and co-residents on recognizing signs and indicators and what can be done if abuse is suspected. For residents, this education can lead to disclosures of violence so we often recommend that the staff of the centers also receive training on responding to disclosures and the importance of professional boundaries in interactions with clientsconsumers.Offer and provide counseling through the local rape crisis center to survivors who disclose and choose to pursue counseling and support services. Also keep in mind that individuals with developmental or cognitive disabilities who act out against others may not have ever had sexuality education, information on boundaries and assertiveness and may even be experiencing violence currently or sometime in the past. Develop an MOU between the rape crisis center and the adult care facility to provide cross-training to staff and to provide sexuality and healthy relationships education to the residents. Since we know that hotline services can be integral in healing, this MOU can also include discuss strategies to ensure that clients of the disability service provider will have private access to the telephone. This MOU can also be developed to include an agreement for a provider to make a referral for rape crisis services if the individual agrees, but is not able to make the call themselves.
 
 
Are TTYs outmoded as a way to communicate with people who are Deaf and hard of hearing? If so, what is the best technology for a program to use to make sure everyone has access to crisis hotlines?
 
1.  Laura
 What is the cost of a VRS for office use?
 
2.  Janice M
 Hi Heather - Thank you for this very useful summary. At this point in time, all 17 of the rape crisis centers in our state (Massachusetts) maintain TTYs, and all have the ability to use the 711 relay. You are correct that very few calls come in to the centers via the TTY lines - the majority of our centers receive no calls over the course of the year. Younger folks who are Deaf seem to be opting for telephone texting as a means of communication. Any additional thoughts that you have on this topic in the future would be most welcome! Thanks for your post.
 
3.  Heather
 While many Deaf individuals are using newer technology from TTYs (such as videophones) some Deaf individuals still prefer to use and feel most comfortable communicating by TTY. If your center has a TTY, you may notice that you don't get a lot of TTY calls but don't give it up as people may still attempt to contact your center through a TTY. The primary technology/resource that most Deaf individuals may choose to use to contact a hearing agency is V(ideo) R(elay) S(ervice). In Texas, as well as some other states, 711 is the universal relay number. You can check your phone book for more information. The national hotline, RAINN offers an online hotline and some programs may want to implement such a service as well. While that may increase access for some Deaf individuals, keep in mind that it may not be completely safe in cases where the sexual assault is part of ongoing domestic violence (computers can be monitored, perpetrators can mimic survivors, etc.). As a hearing agency, if you employ Deaf staff you could obtain a videophone for direct communication between Deaf staff and Deaf clients, eliminating the need for Relay. However, its important to keep in mind that programs may not have the infrastructure to support such technology and community members may not have the experience or knowledge of using videophones as well. In our own work here at SafePlace, we have been able to install four videophones for clients to use two in our shelter and two in our Resource Center. Despite the availability of videophones here at SafePlace, there are Deaf community members who are not familiar with the videophone and choose to use Relay or TTY instead.
 
 
Besides TTY & physical accessibility concerns (wheel chair ramps, etc.) what are some of the other less commonly considered barriers to service for people with disabilities?
 
1.  Heather
 By far a less commonly considered barrier to serving individuals with disabilities is the attitudes of the agency staff. Of significance is the fact that the Americans with Disabiliities Act an American Civil Rights Law was passed in 1990. This law requires that centers provide reasonable modifications so that we are providing the very same goods, benefits and services to people with disabilities as we do to people who do not have disabilities. Eighteen years later we still have programs nationwide that are inaccessible to individuals with a range of disabilities. One way to think about this continued inaccessibility is to consider the attitudes that we hold and how those attitudes can shape our priorities. If our attitudes include misperceptions and stereotypes about individuals with disabilities and we are not willing to assess and change those attitudes and beliefs about people with disabilities, we will continue to make decisions that limit access. Another barrier that commonly goes unexamined is the policies of an agency that may create a barrier to access. For instance, a well intentioned agency establishes a policy that the individual survivor her/himself must call and request services himself during the hours of 9 and 5. This kind of policy can be a good fit for an agency that wants the individual survivor to make the choice and act on her or his own behalf. At the same time, this policy may create a barrier to individuals with disabilities because the individual 1) may not have access to a telephone or 2) may not communicate well over the phone (if they use a communication device or have a speech related disability for instance) and 3) they may feel very safe and comfortable with her/his case manager (who often facilitates phone calls for this survivor). A modification to this policy would allow survivors to have initial intake sessions held in person or to allow a phone call to be placed by a service provider that the survivor identifies. Another less commonly considered barrier is the fact that many programs continue to screen out individuals with disabilities for various reasons (e.g., our staff are not trained to work with people with cognitive disabilities or the individual needs to work on their mental illness before their trauma issues). We often get questions from programs that ask about screening out people with various disabilities. Those programs are surprised when we talk with them about the ADA and the fact that they cannot screen out. An access modification would be to ask screening in questions such as What will help you be successful while you're getting services here. People may not even need any modifications or may not know what adaptations are needed until they are using services. You cant know until you ask.Finally another less commonly considered barrier is the lack of planning budget line items to provide modifications such as sign language interpreters. In 2003, SafePlace conducted a national survey of DV and SA centers and found that only 9 of the responding agencies had a line item in their budget specifically for providing disability related accommodations/modifications. Without these allocations, programs struggle to provide and all too often are not able to provide modifications/accommodations that are needed in order for survivors with disabilities to access services.
 
 
How prevalent is sexual violence against individuals with disabilities in urban communities and are the gender differences significant? Thanks - Linda Luallen
 
1.  Heather
 Unfortunately there is not a lot of research on sexual violence against individuals with disabilities. While this is changing, more researchers are starting to take on this issue (see below). Although it is possible to find statistics that focus on violence against women with disabilities few have focused on sexual violence. Even fewer studies have focused on mens experiences of sexual violence. I was able to find in Dick Sobseys book Violence and Abuse in the Lives of People with Disabilities - The End of Silent Acceptance? (1994) a statistic where he cites that males and females with disabilities were among the victims of sexual abuse females constituted 78.9 and males constituted 21.1 of a University of Alberta sample(1991). (page 80) Sobsey also talks about how sexual abuse seems to be a more frequent problem for men who live in institutions than for girls who live in institutions (1991). (page 81). Other statistics that may be of interest:In a national study on personal assistance abuse, Powers et al. (2002) reported that 67 of the 200 women with physical andor cognitive disabilities interviewed reported lifetime physical abuse and 53 reported lifetime sexual abuse. In addition, 29 of the women reported that the abuse prevented them from being employed; 64 said the abuse prevented them from taking care of their health, and 61 indicated that abuse prevented them from living independently. Powers, L.E., Curry, M.A., Oschwald, M., Maley, S., Saxton, M., & Eckels, K. (2002) Barriers and strategies in addressing abuse: A survey of disabled womens experiences PAS Abuse Survey. The Journal of Rehabilitation, 68(1), 4-13.In a survey of 5,326 North Carolina women, women who reported having a disability were had 4 times more likely to have experienced sexual assault in the last year compared to women without disabilities (Martin, et al., 2006). Martin, S.L., Ray, N., Sotres-Alvarez, D., Kupper, L.L., Moracco, K.E., Dickens, P.A., et al. (2006). Physical and sexual assault of women with disabilities. Violence Against Women. 12(9), 823-837.If youre interested in looking at Dick Sobseys books or examining the other statistics resources we have available, you may want to check out SafePlaces National Lending Library. You can go to www.SafePlace.org to find out more.
 
 
Occasionally I will get called in for an exam on an elderly/MRDD pt that has a Public Administrator for thier guardian, or a guardian.. My question is if they are brought to the ER for treatment (not specfically for Abuse) as a Forensic nurse Do I have a right to conduct a Forensic Exam/collect evidence without the Public Admin/guardians consent? what is the statue in Missouri? (cite it please)
 
1.  Heather
 Hi Kathleen, thanks for your great question. The issue of guardianship is one that can be complicated, and can leave advocates and service providers with more questions than answers. One of the things about guardianship is that it can look different in different cities, towns, counties and states. I'm not an attorney so I can't say for sure what the statutes are in Missouri but I want to refer you (and others) to the resources on guardianship that may help you answer this question (see below). One of the important things to consider is that many perpetrators may automatically state that they are the guardian of an individual with a disability and guardianship may never have been awarded to that individual by a court of law. Its also important to know that guardianship can be obtained at different levels and for different things (e.g., money, medical treatment, or other decisions). It's important to know what level of guardianship someone has been granted by a court in order to know what if any decisions the individual can rightfully make for the person with a disability. For more information on guardianship, you can contact:The National Guardianship Association at www.guardianship.org or by phone at 520-881-6561. You can also contact your jurisdictions probate court. They can answer questions such as the one you posed and it will be specific to your local area.Your states Protection and Advocacy organization (P&A). You can go to www.ndrn.org to locate your states P&A. SafePlace has a free handout on guardianship. The fact sheet can be ordered by downloading a fact sheet order form from the Disability Services page of the SafePlace website at www.SafePlace.org. All of these fact sheets are free and we can get them out to you right away.
 
 
Do you know of any SANE protocols that have been adapted to address the needs of victims of sexual violence who have intellectual disabilities?
 
1.  Janice M
 The SANE Progam in Massachusetts developed protocols many years ago. I am not sure what is in their current protocols. Contact the Director, Lucy Zuniga, at lucia.zuniga@state.ms.us for more info.
 
2.  Heather
 The International Association of Forensic Nurses (IAFN) has been offering workshops on the issue, and contacting them would be a great start to try to figure out what adapted SANE protocols there are. In thinking about adapting protocols, one of the most important things to do is to look at what is happening in your community and how services are currently being provided for survivors with disabilities. With funding or with time, you could conduct a comprehensive needs assessment to find out how services are currently being offered to survivors with disabilities in your community, identify what barriers exist. And then, create an adapted protocol based on the very unique needs of your specific community.If anybody knows specific information on adapted protocols, feel free to post that information here.
 
 
Hello, I am a student at Morgan State University earning my MSW. In 2008, how many disabled people were the victims of sexual violence? How many in the state of Maryland?
 
1.  Carolyn
 Unfortunately, due to the fact that there is no demographic on the Uniform Crime Reports to show a victim of a crime has a disability, these statistics are not available.I would urge disability advocates to contact your state UCR agency to ask them to add a demographic to these forms. Each day over 17,000 police departments complete these forms on victims of crime. The form indicate all demographics from age, race, gender, nature of crime, etc. These are the reports that are then sent to the FBI for their annual crime statistic reports. This also is where most crime victim service grant funding comes from....these types of statistics.We need to also ask our federal agencies like the OVC, the DOJ, and the BJS why this is not being done for the community that is often most vulnerable.It needs to be done ASAP in my mind to give us some real statistics to use.
 
2.  Heather
 Statistics are something that are very helpful in thinking about services that need to be offered and in applying for grants so that survivors with disabilities can be better served. However, stats on this issue, as I talked about in a previous question, can be difficult to obtain. In your state, what you can do to find specific statistics is to contact Adult Protective Services (APS), and that would give you an idea at least of how many cases go through APS, how many are unfounded, how many are founded. You can also Google people with disabilities and sexual violence. Also, your state Sexual Assault and/or Domestic Violence Coalition may have statistics that could be helpful. Look at the previous question on the prevalence of sexual violence against people with disabilities in this forum for broader types of statistics. Contacting your state Protection and Advocacy organization might help you obtain the statistics you are looking for as well. They will have some statistics about abuse perpetrated against people with disabilities.
 
3.  Pam DIckens
 You can get some information from BRFSS data. However, this data does not likely include those who are deaf, live in group or residential settings. A place to start. Our state asks the questions every few years; not annually.
 
 
Please discuss successful strategies to increase accessible resources available to crime victims with developmental disabilities.
 
1.  Jean
 What strategies have been successful in increasing crime victims with developmental disabilities' access to, for instance, rape crisis centers, domestic violence shelters, and law enforcement and prosecutorial resources?
 
2.  Heather
 Jean: I'm glad to answer your question, if you can just clarify what specific resources you are speaking of.
 
 
in many states, victims are offered 24/7 access to information and notification about the locations of their offenders and the status of their court cases. Depending on the victims' special needs and/or disabilities these services may or may not be readily accessible. Could you please offer recommendations on: 1) how service providers could find out about these services for victims; and 2) how best to offer (explain) and assist these victims with registration for automated victim notification services? NOTE 1: these services have back-up access to trained operators. NOTE 2: we have a grant related to the above and continually seek recommendations and experiences of victims to improve these services to enhance their safety and access to justice.
 
1.  Heather Kamper
 If a service provider is interested in finding out where information about Victim Notification is housed within their state, you could start with the VINE website at https:www.vinelink.comvinelinkinitMap.do. This website is the online version of the National Victim Notification Network. Service providers can contact their local Notification Entities for more information on what modifications, if any, are being implemented for survivors with disabilities. If your client has a disability and were to encounter Victim Notification services that are inaccessible, your states Protection and Advocacy Organization (P&A) can offer assistance. Your local P&As office can be found by going online to the National Disability Rights Network website at www.ndrn.org. I applaud the victim centered approach you are using in your services to victims and survivors of crime. Seeking recommendations and experiences of abuse survivors with a wide range of disabilities (including cognitive, physical, sensory and mental illness) provides survivors the opportunity to voice their experience and give ideas for how best to offerexplain the services that you are speaking of. One method of gathering this information is to hold focus groups with community members with disabilities. Consider partnering with your local Center for Independent Living (CIL) or other disability advocacy organizations to provide your staff and the notification systems operators with training on communication and respectful interactions with survivors with disabilities. Include information on how to ensure materials developed about notification services are made available in alternate formats (e.g., large print, simplified language, Braille, audio, etc.) and that interactions between the operators and victimsurvivor are respectful, sensitive, and empowering. For specific strategies in communicating with survivors who have cognitive disabilities, you may want to review the Fact Sheet entitled Tips for Communicating with Survivors with Developmental Disabilities available through the SafePlace website at http://www.safeplace.org/Document.Doc?id=17 or by contacting SafePlaces librarian at llandry@SafePlace.org.
 
 
What are the best methods of resolving PSTD in individuals with mental retardation?
 
1.  Heather
 This is a good question, and it's something that we often get asked. We have a counselor here at SafePlace who has spent much of her career working with survivors with developmental disabilities, and she would be happy to talk to you about what her experiences have been. Contact me if you are interested in speaking with her.
 
 
What financial resources/grants are available to help non-profit agencies better accomodate persons with disabilities? More specifically, are you aware of any national or Florida state agencies that provide free/reduced cost interpreting services to Deaf clients?
 
1.  Heather
 Paying for interpreter services is an issue that many nonprofit crisis service agencies struggle with. To assuage costs, we encourage programs to develop relationships with the interpreter services in their area, and we recommend having services bid to get a reduced fee. I'm not aware of specific grant funding thats available for the cost of interpreter services. As a proactive measure, however, consider adding budget line items to your grants and to your agency budget that will include costs for accommodations and interpreter services. It's important to consider that the core of providing accessible services, whether through interpreter services or through other accommodations, is that staff have what we call attitudinal accessibility and a commitment to serve survivors who have disabilities. In our experience, even with programs that have very little funding, if the staff want to provide services, they will find a way for those services to be provided.
 
 
What steps are DOJ and the Employee Assistance Professionals Association taking to provide education and outreach to workforce systems and employers about the specific issues around violence and people with disabilities?
 
1.  Heather
 I'm not aware of any information on what steps these organizations are taking. I would refer you to DOJ and Employee Assistance Professional's Association for information.
 
 
What specific structural barriers exist in our society to addressing issues of sexual violence against individuals with disabilities (from the perspective of victims, perpetrators, service providers, others)?
 
1.  Heather Kamper
 Attitudes can create barriers that outweigh the physical or programmatic barriers that exist for abuse survivors with disabilities. Common attitudes that impact access include myths related to: 1)the limited impact of sexual violence on abuse survivors with disabilities, 2)danger to staff if an abuse survivor with serious mental illness is served, 3)belief that staff of crisis programs are not trained properly in serving people with disabilities, and 4)beliefs that perpetrators would not assault individuals with disabilities. These attitudes can greatly limit the services that crisis programs offer to an abuse survivor with disabilities. It is important to note that turning away a person based on some characteristic or belief about their disability could be a violation of the Americans with Disabilities Act (ADA). Violations of the ADA are enforced by the U.S. Department of Justice and can result in litigation, fines, and mandated policy change(s). Another barrier is when disability service provider staff limit access to victim services for people with disabilities. Disability service providers are typically not proactive in teaching people with disabilities about interpersonal safety, healthy relationships, and sexuality. They may not think that people with disabilities will understand or benefit or even think that its relevant to provide this type of informationeducation. This often results in people with disabilities having limited awareness or knowledge about their bodies, what constitutes abuse, and what to do if someone hurts them. Consider one definition of attitudinal accessibility adapted from ARCH A Legal Resource for Individuals with Disabilities in Toronto, Ontario, Canada is as follows: Attitudinal accessibility can be defined to mean refusing to accept prejudice, myths and stereotypes about people with disabilities, and identifying and removing any negative attitudes about the capability of people with disabilities. In our work, the attitudes that are held by an agency, its volunteers and staff inform the assessments and the decisions that are made about services (e.g., who gets services, what kind of services, how the services are provided and for how long). In your agency, continually ask: Do the attitudes in our agency create access or build barriers? Then, provide time and non-punitive space for staff to discuss and explore their answers to that question.
 
 
Good afternoon Heather: As we discuss best practices of today and tomorrow, what role do you think collaboration has in respect to promoting systems change for victims and survivors with disabilities in the communities of domestic violence, victim support, criminal justice, law enforcement, provider, self-advocacy and advocacy organizations? Thanks! Darla
 
1.  Heather Kamper
 In our current economy where we are all striving to do more with less, collaboration can play an important role in our work to end violence against individuals with disabilities. Collaboration takes leadership, a commitment of time and staff resources, and willingness to bring all relevant stakeholders to the table. Members of collaborations can come together to identify common interests and goals to end violence perpetrated against peope with disabilities. For collaboration to be effective, the members need to have open conversations and identify how they will handle conflict, disagreements, or opposing viewpoints prior to this occurring. Members of a collaborative can work together to identify the victim service needs and access barriers and work to establish agreements and understandings about how to better share resources and coordinate services. When we collaborate, we can increase the likelihood of developing solutions that meet the needs of survivors with a wide range of disabilities.With respect to systems change, the organizations you mentioned are all important stakeholders in addressing abuse against people with disabilities in our communities. It is best practice to include people who have disabilities and not just service providers. The role of the collaboration may be to address accessibility and service capacities within each member organization andor collectively promote policy change within state and local government that improves the response to people with disabilities accessing law enforcement, sexual assault crisis services, healing services and SANE exams.
 
 
Are low- income African American disable teen girls at higher risk of becoming victims of sexual violence than low- income Caucasian teen girls?
 
1.  Heather Kamper
 The specific data you are interested in is difficult to find in the limited research that has been conducted on violence against teens with disabilities. According to the 2000 U.S. Census, the African American community has the highest rate of disability at 20.8 percent, slightly higher than the overall disability rate of 19.4 (retrieved from http://www.census.gov/population/www/pop-profile/disabil.html). A more detailed search on Violence Against Women Network (VAWNET) with these search criteria (http://new.vawnet.org/category/index_pages?category_id496) did not yield any results. I will refer you to the previous questions on statistics asked during this forum and encourage you to keep searching for this data. A comprehensive literature review could yield more findings than this data. If someone has the means to do such a review, please post your findings on this forum so that we may all benefit. Additionally, the work of the Institute on Domestic Violence in the African American Community may be of interest to you. While their focus is not on sexual violence, there was a webcast and a special issue recently published in The Journal of Aggression Maltreatment & Trauma on Domestic Violence and People of Color with Disabilities. For more information, visit http://www.dvinstitute.org/announces/announcement8.html.
 
 
Sometimes victims do not know they could have filed under a CVC Program, or because of the trauma, they do not want to file, thus what is the statues of limitations on filing a claim??
 
1.  Heather Kamper
 It is true that for many reasons, individuals who are survivors of crime may choose not to file a CVC claim immediately following the crime. The statute of limitations for filing Crime Victims Compensation claim varies from state-to-state. In Texas, for example survivors must file within two years or with good cause within five years. Other states, like Virginia, will accept Crime Victims Compensation applications anytime following a sexual assault as long as the survivor shows good cause for the delay and the rape was reported to law enforcement within 120 days. In Virginia, survivors of child sexual abuse must file CVC claims within ten years of their 18th birthday. Contact your individuals state Crime Victims Compensation program office as administrative guidelines/procedures may be different from state to state. In some states, this is the State Office of the Attorney General.
 
 
Consider El Paso is a Border city with Mexico, what services/options are available for persons with disabilities who are not legal residents of the US?
 
1.  Heather Kamper
 According to Chapter 420 of the Texas Government Code, there are no requirements for sexual assault programs funded through the Office of the Attorney General (OAG) to inquire as to a clients immigration status. Therefore, most staff of rape crisis centers will not ask clients to show documentation of status and the absence of this documentation will not prevent most survivors from receiving services whether or not the individual has a disability. To receive publicly funded disability/social services in Texas, a person must be a U.S. citizen or reside in the U.S. on a work permit, student visa or legally granted permanent residency. For example, the state agency providing employment rehabilitation services to people with disabilities (Texas Department of Assistive and Rehabilitative Services DARS) will not serve a person unless they have immigration documentation. Information on legal assistance with immigration issues can be found at http://www.americangateways.org. Additional services available for people with disabilities in Texas can be found by calling 211 or going to the United Way website at www.211centraltexas.org.
 
 
I am the coordinator of a Sexual Assault Multidisciplinary Action Response Team. Can you suggest a few specific examples of how a mutidiscipinary team might approach and engage their community in assuring support for individuals with diabilities who have experienced sexual violence?
 
1.  Heather Kamper
 One way to engage your community and increase supports to abuse survivors with disabilities is to invite disability and victim service providers to join you in conducting an assessment of victim services and support needs. Its important that you also invite survivors with a range of disabilities (and their allies) to be part of this assessment and to take part in your action response team. The voices and experiences of survivors with disabilities need to be included in any evaluation and examination in order to truly improve services and ensure access to survivors with disabilities. Based on what is learned in your needs assessment, you could then hold a community wide multidisciplinary meeting or training to increase the communitys knowledge about the service needs and the safety issues abuse survivors with disabilities are facing. This kind of meeting can also be helpful for initiating and strengthening relationships and talking about the next steps for your community to ensure you are enacting the best practices in victim services for abuse survivors with disabilities.
 
 
What is the penalty for persons who commit sexual violent crimes against individuals with disabilities and who decides what these penalties should be? Does the crime fit the punishment?
 
1.  Heather Kamper
 Different jurisdictions will have different sentencing standards that are specific to the various forms of sexual violence that are perpetrated. In our jurisdiction, if a person commits a crime against a vulnerable adult in some cases, the district attorney can file for an enhancement. The enhancement can increase the perpetrators sentence and, if the crime is a misdemeanor, increase the charge to a felony. Contact your local law enforcement authority to obtain information for the specific charge you want to learn more about.
 
2.  Carolyn
 Some states have enhanced sentencing guidelines for sexual assaults, or other crimes, where the crime victims have a disability.You would have to check the criminal law statutes in your state to see if they do exist.
 
 
Do you have any suggestions for resources specific to intimate partner sexual violence and disability issues?
 
1.  Heather Kamper
 Unfortunately, there are limited resources that specifically focus on sexual assault that is perpetrated in the context of intimate partner relationships where one or both partners have a disability. If there are resources that others know about, please post so that we can all benefit. The following organizations and websites can be helpful in your quest for information about intimate partner sexual violence and disability issues: National Resource Center for Domestic Violence (NRCDV): www.nrcdv.org ~ National Sexual Violence Resource Center (NSVRC): www.nsvrc.org ~ Office for Victims of Crime (OVC): www.ovc.gov ~ Rape Abuse Incense National Network (RAINN): www.rainn.net and 800-656-4673 ~ Violence Against Women Network (VAWNET): www.vawnet.org ~ For more information on a personal story of survival from sexual assault at the hands of a partner, you can purchase the video Disability, Violence and Survival: A Personal Story from SafePlace. The video documents the experience of a woman who has acquired a disability and experiences sexual assault of her partner as well as by unknown perpetrators through a gang rape. More information about the video, visit the SafePlace website at www.SafePlace.org or contact llandry@SafePlace.org.
 
 
Outreach and breaking barriers to provide help to this population. Our agency has issues reaching out effectively, do you have any insight?
 
1.  Heather Kamper
 There are many outreach strategies that can make your agency more welcoming to people with disabilities. One resource is SafePlaces curriculum Balancing the Power: Creating a Crisis Center Accessible to People with Disabilities that can be ordered from www.SafePlace.org. Some basic strategies that may be helpful are 1) building relationships with local disability service providers 2) including accessibility information in your existing agency brochures and materials and website, 3) recruiting people with disabilities as volunteers/staff, 4) distributing brochures at places that are frequented by people with disabilities, and 5) when advertising for public events, indicate that they are being held in accessible locations. Additional strategies include offering personal safety and sexuality classes to people with disabilities, cross-training with disability service providers, and submitting proposals to present at disability related and self-advocate conferences. When planning and implementing outreach strategies, it is critical to ensure the local sexual assault and domestic violence centers are truly accessible to survivors who are going to respond to your outreach efforts. When giving information on shelter services, include clear details on what happens if space is not available, how to stay connected until space is available, the process for determining eligibility for shelter, and how decisions are made about who gets in when space is limited.
 
 
Have any states passed new laws that are particularly helpful in prosecuting these cases?
 
1.  Heather Kamper
 I encourage you to contact the National District Attorneys Association for help in identifying new laws that have been helpful in prosecuting cases of sexual violence against individuals with disabilities. For the past several years, they have offered at least one workshop at each of their Annual Conferences about the specifics of prosecuting cases of abuse against individuals with disabilities. You can check out their website at www.ndaa.org or you can contact them 703-549-9222. Another resource is the Barrier Free Justice program of the Office of the District Attorney, Kings County (NY). The program began in 2000 and has assisted women with cognitive, psychiatric and/or physical disabilities who have sexual assault or domestic violence cases pending in Brooklyn. You can contact them at 718-250-2000 or online at http://www.brooklynda.org/barrier_free_justice/barrier_free_justice.htm. Additionally, The Office on Violence Against Women produced a DVD that specifically focuses on prosecution of cases of violence against individuals with disabilities. The information about it is below: Crime Victims with Disabilities: What the Prosecutor Needs to Know About Autism, Cerebral Palsy, Mental Retardation & Traumatic Brain Injury 2006 CDAA, Funded by the United States Department of Justice Office on Violence Against WomenDescription:In this two and one-half hour DVD program, experts from across the United States, in the fields of prosecution, law enforcement, medicine, education, and social services, present techniques for accommodating individuals, conducting interviews, and presenting cases in court. Diagnoses of autism, cerebral palsy, mental retardation and traumatic brain injury are explained. Individuals with disabilities share perspectives and experiences. A model interagency team response is profiled.Target Audience:This program is designed for professionals responsible for the investigation and prosecution of crimes against adults with disabilities, particularly of a communicative or cognitive nature.MCLE:Attorneys licensed by the California State Bar may earn two and one- half hours of self-study credit. Attorneys outside of California should check with their own State CLE requirements.Cost:Free to prosecutors and law enforcement while supply lasts. This program is only available in DVD. Professionals in other categories may call CDAA to inquire.Ordering:Interested individuals should call CDAA Phone: 916-443-2017.
 
 
Hello, Thanks for leading the discussion. What are some of the major barriers to working with this population? Robin
 
1.  Heather Kamper
 The attitudes of a crisis centers leadership and staff will be reflected in the policies and practices that influence who get services, what kind of services, and for how long. If you want to identify the major accessibility barriers in your agency, you might begin by asking the following questions: Are we serving people with disabilities?Are we serving people who are Ddeaf? Are we providing people with disabilities or who are Ddeaf the very same victim services as we provide to survivors who are not Ddeaf or who do not have disabilities? If not, what would need to change in order to do so?What are the service gaps? What are the barriers? What are the needs? What keeps people with disabilities out of our agency? What keeps people who are Ddeaf out of our agency? Many programs find it difficult to allocate funds for sign language interpreters or for disability related needs or modifications (e.g., emergency personal attendant services for survivors with spinal cord injuries or wheelchair access to certain buildings or facilities). As a result, participation in programs may be more limited or provided in ways that are isolating to the survivor who is Ddeaf or has a disability. People themselves with disabilities and who are Ddeaf share that accessibility is more about attitude than anything else. To support attitudinal accessibility, provide agency staff with opportunities to talk about their experiences, fears, biases and needs for information regarding people who are Ddeaf or people who have disabilities. When attitudes are open and committed to removing services gaps and barriers, the word quickly gets around and will reflect that your agency is committed to doing whatever it takes to remove access barriers. For many centers, the hardest part of access is rebuilding their reputation within the community after turning away or failing to remove access barriers to abuse survivors with disabilities or who are Ddeaf.
 
 
Can you recommend prevention training curriculum in this area for young adults with disabilities?
 
1.  Heather Kamper
 In our work with young adults with a range of disabilities, SafePlace educators often use the LifeFacts Sexual Abuse Prevention, No, Go, Tell! and the Sexuality Education for Persons with Severe Developmental Disabilities curricula. These materials can be purchased through James Stanfield Publishing Company (http://www.stanfield.com/). If you'd like to borrow these materials, they are available for loan from SafePlaces Lending Library. For more information on the library, check out our website at www.SafePlace.org. Disability Services educators developed and wrote the publication I discussed in an earlier question entitled Kid and Teen Safe: An Abuse Prevention Program for Youth with Disabilities. This resource is free and can be downloaded from www.vawnet.org.
 
 
What age group do you think would be most vulnerable?
 
1.  Heather Kamper
 Its important to recognize that not only age, but the individuals specific type of disability, residential setting and many other variables impact an individuals risks of being targeted for all forms of violence, including sexual violence. Its important to note here that regardless of what factors may increase someones risk for experiencing sexual violence, the offender is to be held accountable for hisher actions of violence. For specific statistics on children with disabilities and their experiences of violence, I encourage you to research Patricia Sullivan and the Boys Town National Research Hospital in Nebraska. For information on abuse of older adults you can contact the National Clearinghouse on Elder Abuse (NCEA) online at www.ncea.aoa.gov or the National Clearinghouse on Abuse in Later Life (NCALL) at www.ncall.org. A comprehensive literature review on the issues of age, risk factors or vulnerability and sexual violence would help us identify what resources and findings are available. A study that may be of interest to you does address the impact of adverse childhood experiences (including sexual and physical violence) and their link to adult health and well-being. You can learn more about the study at www.ACEstudy.org.
 
 
My question is what are the elder abuse issues that are happening in the nursing percent rate? what is being done to help this issue?
 
1.  Heather Kamper
 For specific statistics and up to date information about the work that is being done on this issue, I encourage you to contact:National Clearinghouse on Abuse in Later Life (NCCALL): www.ncall.us ~ National Clearinghouse on Elder Abuse (NCEA): www.ncea.aoa.gov ~ National Resource Center on Domestic Violence (NRCDV): www.nrcdv.org ~ National Sexual Violence Resource Center (NSVRC): www.nsvrc.org ~ Pennsylvania Coalition Against Rape (PCAR): www.pcar.org ~ Violence Against Women Network (VAWNET): www.vawnet.org Your states Protective Services can also be a resource in obtaining information about the statistics of abuse of older adults. You can contact the National Adult Protective Services Association (NAPSA) online at www.napsa.org for more information.
 
 
The agency I work for investigates abuse and neglect for seniors and people with disabilities. It can be very hard to interview MRDD clients who have been abused. Any suggestions or help would be appreciated.
 
1.  Heather Kamper
 Our work focuses on providing safety, healing and prevention services here at SafePlace. We don't conduct forensic interviews however, we have spent many years providing trainings targeted to people with developmental disabilities and to Adult Protective Services. Here are some resources that you may find helpful. The Office for Victims of Crime (OVC) produced a video entitled Victims with Disabilities: The Forensic Interview-Techniques for Interviewing Victims with Communication andor Cognitive Disabilities. Information about this free video can be found online at http://www.ovc.gov/publications/infores/other.htm#forensicinterview. A resource that is available for loan through SafePlaces Lending Library is The Sexual Abuse Interview for Those with Developmental Disabilities by Denise Valenti-Hein, Ph.D. and Linda D. Schwartz, Ph.D. This interview curriculum is published by the James Stanfield Company. If youre interested in reviewing the Sexual Abuse Interview before you purchase, it is available to borrow through SafePlaces Lending Library. Visit http://www.safeplace.org/Page.aspx?pid320 for information on borrowing policies.Another resource available from the SafePlace Lending Library is a book written by Nora Baladarian entitled Interviewing Skills to Use with Abuse Survivors Who Have Disabilities published in 1998. For more information about this and her other resources, you can visit Noras website at http://www.norabaladerian.com. Additionally, SafePlaces Disability Services staff developed a communication board using Picture Communication Symbols (PCS). This communication board can be used for abuse disclosures. The board includes symbols that communicate bruise, hit, hurt, penis, vagina, etc. We know that many individuals who use PCS have not had access to such abuse specific types of icons. The boards can be purchased at cost - $10.00. If youre interested you may contact Lesley Landry at llandry@SafePlace.org.Independence First, a Center for Independent Living located in Wisconsin developed a communication book to facilitate disclosures of abuse by individuals with disabilities. This resource is available for borrowing from our Lending Library. For more information, you can also contact Independence First at 414-291-7520 (vtty) or online at www.Independencefirst.org.
 
2.  Carolyn
 Please review the series of six educational fact sheets and two brochures that have been created for victims of crime with autism. www.leanonus.org This may assist you and resources are also listed. I would also suggest there be some forensic interviewers trained in this area specifically to assist with these cases.
 
 
Is there any research on therapies that help individuals with disabilities who have been subject to sexual violence recover? Are there training programs for providers wanting to provide such therapies?
 
1.  Heather Kamper
 One of the few resources we have in this work is a video entitled Alone in a Crowd and it features Canadian researcher Dick Sobsey. This video discusses the experiences of Canadian counselors who are providing therapeutic support to individuals with cognitive disabilities. Alone in a Crowd is available for loan through SafePlaces Lending Library. I encourage you to also review the book Counseling People with Developmental Disabilities Who Have Been Sexually Abused by Sheila Mansell and Dick Sobsey if you're interested in specific approaches that can be helpful in providing healing services to abuse survivors with developmental disabilities.
 
 
Do you know of any national regulations / policies around group homes hiring staff without criminal background? How is the issue of staff perpetrator most often addressed?
 
1.  Heather Kamper
 To our knowledge, there are currently no national policies that prevent group homes from hiring someone with a criminal background. There are some state, local and agency policies that require a clean background check for employment, but these regulations vary. For example, in California it is a licensing requirement that group homes funded by the state ensure that staff working with minors and adult with developmental disabilities do not have a criminal background. The issue of staff perpetrators again varies. Most states require mandated reporting of suspicions of abuse. In those cases, the agency responsible for investigating reports of abuse (e.g., Adult Protective Services) may require the agency take action. That does not always effectively ensure the staff person is removed from the agency. In some cases, the individual may be reassigned to another home, the individual with a disability may be removed from the home or no action is taken.
 
2.  Carolyn
 Pam, I'm not familiar with federal requirements that provide this standard. However in the state of MI where I am from the state's mental health code indicates there is this requirement and individuals cannot be convicted of certain felonies nor lessor crimes involving assaults or theft.Many states also have enacted legislation to ensure this. The problem is however many perpetrators go from state to state and there is not a national data base to show violations across the board. Each check has to be done by state of conviction generally.
 
 
What are the issues facing sexually abused individuals with disablities in the LGBT community?
 
1.  Heather Kamper
 Abuse survivors with disabilities who identify as LGBTQ experience many of the same barriers as survivors with disabilities who do not identify as LGBTQ. However, the survivor may face additional barriers to accessing rape crisis services. For an individual who is not out, they may not feel comfortable in asking for help. Individuals may not be aware that same sex sexual assault can happen. Other individuals may not believe that they have a right to ask for help because their relationship is not seen as a valid relationship. Addressing the role of internalized oppression is important when working with survivors who have disabilities and identify as LGBTQ. Consider the following definition that oppression becomes internalized when an individual comes to believe and act as if the oppressor's beliefs system, values, and life way is reality. (Retrieved from http://www.letswrap.com/nadvinfo/internal.htm). It is important to keep in mind that for some survivors, they may not be aware of the role that internalized oppression is playing in their understanding of their experience of sexual violence and their choice to pursue services.
 
 
What is the rate of sexual abuse among individuals with disabilites against other individuals with disabilites? Is it prevalent and how is the situation best addressed?
 
1.  Heather Kamper
 There is very limited research on the topic of sexual abuse against individuals with disabilities. In Violence and Abuse in the Lives of People with Disabilities (1994), Dick Sobsey cites a study of 215 survivors of abuse in which 9.1 of the offenders were peers with disabilities. Some individuals with developmental disabilities exhibiting abusive behaviors towards others may be an attempt as van der Kolk (1989) states to gain mastery over an original trauma. Individuals with disabilities may have never been given the opportunity to process a traumatic event and therefore may carry that experience into their interactions with others. For others who have never been given education about healthy sexual expression, abusive behaviors toward others may be indicators of a need for such education. Despite the complexity of this issue, it is important to provide the needed education, have accessible resources for therapeutic support for individuals with disabilities who have experienced sexual violence, and still hold those who perpetrate violence accountable. The Arc of New Jerseys Developmentally Disabled Offenders Program at http://www.arcnj.org/programs/special_programs.html?special_programs_item=44458&db_item=listitem may be a resource for more information on the question posed.
 
 
is the behavior the same with people with mental disabilites that have been victims of sexual violence. How can you tell if they have been abuse.
 
1.  Heather Kamper
 The behaviors and experiences of abuse survivors with cognitive disabilities can be similar to that of abuse survivors who do not have disabilities. There are some unique factors though if the person lives in a setting where a behavioral plan may be instituted to try to change the behaviors rather than recognizing that the behaviors may be a sign of abuse or other trauma.One consideration is that people with developmental disabilities have often been trained to be compliant and to please others. As a result, they may try to hide any signs that something is wrong or that anything has happened to them. It may be helpful to be sensitive to the occurrence of symptoms such as nightmares and trouble sleeping, over or under eating, anxiety and hyper-vigilance, and self-injury among others. Be aware however, that that these symptoms can also be related to medical issues or other experiences of trauma. Discussing your concerns about the persons behaviors with other service providers and family members, in addition to the person you are concerned about, may give you a more complete picture of what is going on in that persons life and how you can best support them. Exercise caution however as the individuals family members andor other service providers may be a perpetrator and interviewing these individuals requires thoughtfulness and consideration in order to minimize risks for further abuse. For more information on considerations when asking about abuse experiences see the SafePlace informational fact sheet Inquiring About Abuse Experiences. More information about possible non-verbal and indirect disclosures of abuse is included in the SafePlace fact sheet Indicators or Reactions to Abuse or Neglect. These informational fact sheets are free and can be ordered by visiting www.safeplace.org/Document.Doc?id=17.
 
 
What would be the course of treatment for sexual violence individuals with disabilities?
 
1.  Heather Kamper
 Healing services and supports can be similar for people with and without disabilities. There are however, some unique factors to keep in mind: the person may have had their trust and civil rights violated many times by professionals, service providers and family members. In addition, the survivor may have experienced overprotection in effort to be kept safe which could result in mild to extreme control by others over most aspects of their lives. For individuals with cognitive disabilities, it may take longer to process information and alternative therapies such as art, music and role playing can be very effective. You may find healing services are more effective if provided for shorter durations of time and over longer periods of time for people with cognitive disabilities. In addition, allowing a trusted service provider to accompany the survivor at the beginning of sessions (if this is the individuals preference) can also help to ensure that counseling is welcoming for abuse survivors with cognitive disabilities. If youre interested in this topic, I encourage you to review Counseling People with Developmental Disabilities Who Have Been Sexually Abused by Sheila Mansell and Dick Sobsey. For additional information on general counseling techniques with individuals who have cognitive disabilities, you can check out Counseling Adults with Mental Retardation a Procedures and Training Manual by Larry Jageman and Jane Myers. Both of these books are available for loan through SafePlaces Lending Library. Visit www.safeplace.org/Page.aspx?pid=320. Additionally, an article that was recently published in the MayJune 2009 edition (Volume 12, Number (5) Sexual Assault Report may be of interest to you. This article, written by SafePlaces Lee Ann Cameron, LBSW focuses specifically on her experiences in providing counseling and education to survivors of abuse who have disabilities.
 
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