A National Teleconference TRAINING MANUAL September 22 and 23, 1999 BARRIERS TO INDEPENDENCE: ABUSE IN THE LIVES OF INDIVIDUALS WITH DISABILITIES IL NET NCIL/ILRU National Training & Technical Assistance Project 1999 ILRU Program 2323 S. Shepherd, Suite 1000 Houston, TX 77019 713-520-0232 (v) 520-5136 (TTY) 520-5785 (fax) Permission is granted for duplication of any portion of this manual, providing that the following credit is given to the project: Developed as part of the IL NET: ILRU/NCIL National Training and Technical Assistance Project. Substantial support for development of this publication was provided by the National Institute on Disability and Rehabilitation Research and Rehabilitation Services Administration, U.S. Department of Education. The content is the responsibility of ILRU, and no official endorsement of the Department of Education should be inferred. TABLE OF CONTENTS Section 1: Agenda Goals Learning Objectives List of Presenters and IL NET Staff About the IL NET About ILRU, About NCIL About the Presenters and their Programs Pre-Conference Discussion Section 2: Teleconference Outline Section 3: Teleconference Handouts Section 4: Additional Resources Other Reference Information Teleconference Audio Tape Order Form Teleconference Evaluation BARRIERS TO INDEPENDENCE: ABUSE IN THE LIVES OF INDIVIDUALS WITH DISABILITIES AGENDA September 22 and 23, 1999 A. Pre-conference discussion at sites 1. Distribute materials and read the pre-conference discussion information and caution notice. 2. Please discuss the following questions prior to the teleconference: Make a list of the agencies/services in your area that provide assistance to victims/survivors of abuse. Of those agencies/services listed, have they worked with people with disabilities? Do they have knowledge about providing services to individuals with disabilities? How could your Center for Independent Living collaborate more or work to educate those agencies/services to better meet the needs of individuals with disabilities? Does your center have an awareness of the issues of abuse. If so, what services do you offer and do you have a policy on how to deal with abuse that is disclosed by consumers? What do you hope to obtain by participating in this teleconference? B. Live Teleconference a. Welcome and Overview b. Teleconference Goals c. Introductions of Presenters d. Learning Objectives and Questions to Panelists e. Resources f. Conclusion C. Post-teleconference Activity What steps could your Center for Independent Living take to collaborate/educate those agencies/programs that provide assistance to victims/survivors of abuse? Ask participants to identify any additional information/topics that could be covered in future teleconferences. Complete evaluation form. GOALS 1. Create an awareness in centers for independent living regarding abuse and individuals with disabilities. 2. Develop communication between independent living centers working on the issues of abuse. LEARNING OBJECTIVES 1. Learn about the prevalence of abuse and the differences in the way abuse is experienced by individuals with disabilities. 2. Find out how to identify abuse and what to do if abuse is disclosed. 3. Offer ideas on how centers for independent living can build supports and network with survivor services to insure access for individuals with disabilities. 4. Gain knowledge of three independent living centers that are addressing abuse issues, how they started and what they do. 5. Discuss the issues of accessing services and the sensitive nature of these activities. 6. Know where to go for more information on these topics. LIST OF PRESENTERS AND IL NET STAFF PRESENTERS Leslie Myers, M.S., C.R.C., C.D.V.C. IndependenceFirst 600 West Virginia, Suite 301 Milwaukee, WI 53204 (414) 291-7520 (V/TTY) (414) 291-7525 (Fax) lmyers@independencefirst.org Margaret "Peg" Calvey LEAP/Center for Independent Living 2100 North Ridge Road Elyria, OH 44035 (440) 324-3444 (V) (440) 324-2113 (TTY) (440) 324-2112 (Fax) Debora Beck-Massey Domestic Violence Initiative P.O. Box 300535 Denver, CO 80203 (303) 839-5510 (V/TTY) (303) 839-1181 (Fax) DVIdenver@aol.com Hillary Colby Access Living 310 S. Peoria, Suite 201 Chicago, IL 60607 (312) 226-5900 Ext. 634 (V) (312) 226-1687 (TTY) (312) 226-2030 (Fax) colby@accessliving.org Nancy Swedlund, Psy.D., CROWD - Center for Research on Women with Disabilities Baylor College of Medicine 3440 Richmond Avenue, Suite B Houston, TX 77046 (713) 960-0505 (V/TTY) (713) 961-3555 (Fax) swedlund@bcm.tmc.edu Margaret Nosek, Ph.D. CROWD - Center for Research on Women with Disabilities Baylor College of Medicine 3440 Richmond Avenue, Suite B Houston, TX 77046 (713) 960-0505 (V/TTY) (713) 961-3555 (Fax) mnosek@bcm.tmc.edu Roberta E. Sick, M.Ed., C.R.C., L.P.C. University Affiliated Program - UAMS IL NET STAFF ILRU Lex Frieden Laurie Gerken Redd Executive Director Administrative Director lfrieden@ilru.org lredd@ilru.org Richard Petty Carri George Program Director Publications Coordinator richard.petty@bcm.tmc.edu cgeorge@ilru.org Laurel Richards Dawn Heinsohn Training Director Materials Production Specialist lrichards@ilru.org heinsohn@ilru.org ILRU Program 2323 S. Shepherd, Suite 1000 Houston, TX 77019 (713) 520-0232 (V); 520-5136 (TTY); 520-5785 (Fax) ilru@ilru.org NCIL Anne-Marie Hughey Raymond Lin Executive Director Logistical Coordinator amhughey@aol.com raymond_lin@msn.com Michael Schmitz Logistical Assistant mds_ncil@hotmail.com 1916 Wilson Blvd., Suite 209 Arlington, VA 22201 (703) 525-3406 (V); 525-4153 (TTY); 525-3409 (Fax) ncil@tsbbs02.tnet.com ABOUT THE IL NET This training program is sponsored by the IL NET, a collaborative project of Independent Living Research Utilization (ILRU) of Houston and the National Council on Independent Living (NCIL). The IL NET is a national training and technical assistance project working to strengthen the independent living movement by supporting centers for independent living and state councils on independent living. IL NET activities include workshops, national teleconferences, technical assistance, on-line information, training materials, fact sheets, and other resource materials on operating, managing, and evaluating centers and SILCs. The mission of the IL NET is to assist in building strong and effective CILs and SILCs which are led and staffed by people who practice the independent living philosophy. The IL NET operates with these new objectives: Assist CILs and SILCs in managing effective organizations by providing a continuum of information, training, and technical assistance. Assist CILs and SILCs to become strong community advocates/change agents by providing a continuum of information, training, and technical assistance. Assist CILs and SILCs to develop strong, consumer-responsive services by providing a continuum of information, training, and technical assistance. ABOUT ILRU The Independent Living Research Utilization (ILRU) Program was established in 1977 to serve as a national center for information, training, research, and technical assistance for independent living. In the mid-1980's, it began conducting management training programs for executive directors and middle managers of independent living centers in the U.S. Since 1985, it has operated the ILRU Research and Training Center on Independent Living at TIRR, conducting a comprehensive and coordinated set of research, training, and technical assistance projects focusing on leading issues facing the independent living field. ILRU has developed an extensive set of resource materials on various aspects of independent living, including a comprehensive directory of programs providing independent living services in the U.S. and Canada. ILRU is a program of TIRR, a nationally recognized, free-standing rehabilitation facility for persons with physical disabilities. TIRR is part of TIRR Systems, a not-for-profit corporation dedicated to providing a continuum of services to individuals with disabilities. Since 1959, TIRR has provided patient care, education, and research to promote the integration of people with physical and cognitive disabilities into all aspects of community living. ABOUT NCIL Founded in 1982, the National Council on Independent Living is a membership organization representing independent living centers and individuals with disabilities. NCIL has been instrumental in efforts to standardize requirements for consumer control in management and delivery of services provided through federally-funded independent living centers. Until 1992, NCIL's efforts to foster consumer control and direction in independent living services through changes in federal legislation and regulations were coordinated through an extensive network and involvement of volunteers from independent living centers and other organizations around the country. Since 1992, NCIL has had a national office in Arlington, Virginia, just minutes by subway or car from the major centers of government in Washington, D.C. While NCIL continues to rely on the commitment and dedication of volunteers from around the country, the establishment of a national office with staff and other resources has strengthened its capacity to serve as the voice for independent living in matters of critical importance in eliminating discrimination and unequal treatment based on disability. Today, NCIL is a strong voice for independent living in our nation's capital. With your participation, NCIL can deliver the message of independent living to even more people who are charged with the important responsibility of making laws and creating programs designed to assure equal rights for all. ABOUT THE PRESENTERS AND THEIR PROGRAMS Margaret Nosek has a Ph.D. in rehabilitation and a Master of Arts in rehabilitation counseling from the University of Texas, Austin, and a Master of Arts in Music from Case Western Reserve University. Dr. Nosek has been a faculty member in the Department of Physical Medicine and Rehabilitation at Baylor College of Medicine since 1984. She holds the rank of full professor. Dr. Nosek is an internationally recognized authority on women with disabilities and independent living for persons with disabilities. During her first ten years at Baylor she served as Director of Research for the Independent Living Research Utilization program at The Institute for Rehabilitation and Research. In 1992, she established the Center for Research on Women with Disabilities within the Department of Physical Medicine and Rehabilitation and continues to serve as its director. Over her 14 years at Baylor College of Medicine she has been awarded more than $4 million dollars in federal and private grant funds for research and training. She has done considerable research and writing on developments in public policy that affect the ability of people with disabilities to live independently in the community. Dr. Nosek's accomplishments are reflected in her 35 articles published in refereed academic journals, 15 chapters in academic textbooks, 91presentations at national conferences of scholarly organizations and many presentations at international conferences outside of the United States. She has served on the Affirmative Action Committee since 1990 and chairs its subcommittee on disability. In this capacity, she developed and implemented a full agenda of activities to increase the awareness of disability issues at Baylor. Dr. Nosek is the recipient of numerous awards for her research and advocacy by local, state and national organizations. As a person with a severe physical disability, she has been both a pioneer and an activist in the disability right movement, including vigorously supporting passage of the Americans with Disabilities Act. The President's Committee on Employment of People with Disabilities has honored her as a "Disability Patriot." Nancy Swedlund, Psy.D.,, is a postdoctoral fellow at the Center for Research on Women with Disabilities at Baylor College of Medicine in Houston, Texas. Dr. Swedlund received her doctorate in psychology from the Minnesota School of Professional Psychology in August 1998. Her research at the Center for Research on Women with Disabilities consists primarily of working on two projects related to violence against women with disabilities. One project is a survey of Centers for Independent Living regarding their work on abuse issues. The second project involves development and field testing of an abuse screening instrument designed to be used in medical settings to help medical personnel identify women with disabilities who are experiencing abuse. The Center for Research on Women with Disabilities (CROWD) at Baylor College of Medicine, Houston, is a research center that focuses on issues related to health, aging, civil rights, abuse, and independent living. CROWD's purpose is to promote, develop, and disseminate information to expand the life choices of women with disabilities so that they may fully participate in community life. More specifically, researchers develop and evaluate models for interventions to address specific problems effecting women with disabilities. Leslie A. Myers, M.S., C.R.C., C.D.V.C., received a Master of Science, Educational Rehabilitation Counseling degree from the University of Wisconsin-Milwaukee, in addition to being awarded a trauma counseling certificate, certified rehabilitation counselor and certified domestic violence counselor. She began working at IndependenceFirst in May 1998 as an independent living coordinator, peer counselor and advocate. As an extension of the peer counseling program, Leslie has developed a program called "S.A.F.E." (Stopping Abuse For Everyone) which deals with abuse issues of individuals with disabilities. She has written two manuals, "Serving Women with Disabilities: A Guide for Domestic Abuse Programs" and "Working with Abuse Survivors: A Guide for Independent Living Centers", as well as authoring a chapter for the Wisconsin Coalition Against Sexual Assault on sexual assault and individuals with physical and sensory disabilities. IndependenceFirst has a vision for full inclusion of persons with disabilities in every aspect of our community and commits itself toward this end. IndependenceFirst is a non-profit agency directed by, and for the benefit of, persons with disabilities, primarily serving the four county metro-Milwaukee area. In 1978, a group of Milwaukee area rehabilitation professionals and persons with disabilities met to establish a Center for Independent Living. Their efforts led to a grant proposal submitted to the Division of Vocational Rehabilitation to be funded by the Rehabilitation Services Administration (RSA). The proposal was approved and a new agency, the Southwestern Wisconsin Center for Independent Living, Inc. (SEWCIL), was incorporated as a not-for-profit agency in July 1979. In 1995, SEWCIL's name was changed to IndependenceFirst to better reflect the mission of our organization. Our mission is to effectively facilitate empowerment through education, advocacy, independent living services, and coalition building. We promote diversity and multicultural participation in our operation and services. Debora Beck-Massey is a graduate of the University of Northern Colorado with a BA in sociology and women's studies. She holds certificates in rape advocacy, domestic violence, victim advocacy and hate crime (train the trainer). She also has over 7 years of experience in these fields. She has done presentations on disability awareness, domestic violence, and sexual assault and how women are affected, plus has the knowledge of how to integrate these subjects into human resource agencies and policies. Ms. Beck-Massey is a survivor of these issues and works to educate others on the subject. She has presented to numerous agencies including the following: Battered Women's Justice Project, Colorado Organization for Victim's Assistance, National Coalition Against Domestic Violence, National Multiple Sclerosis Society to name a few. She is a member of Denver Sexual Assault Interagency Council, National Coalition Against Domestic Violence, Denver Protocol for Adults at Risk, Denver Task Force Against Domestic Violence, MOSAIC (a multicultural organization), and Colorado Association of Nonprofit Organizations. Domestic Violence Initiative (DVI) for women with disabilities has been in existence since 1985 under the direction of founder Sharon Hickman. DVI's mission is to create, promote, and support viable alternatives for women with disabilities who are victims/survivors of domestic violence or caretaker abuse. DVI believes that education, awareness and knowledge of the issues facing those victimized will help prevent society's further discrimination and subsequent victimization of women with disabilities. Margaret "Peg" Calvey has been the education and training coordinator at LEAP/CIL since 1997. In this capacity she is responsible for curricula used in community education on disability issues. She is the developer of the "SWEAP" project, a program that addresses the issue of women with disabilities and violence/abuse, and serves as that project's coordinator. Prior to LEAP/CIL, she had a twenty-year career as a classroom teacher in a private inner-city elementary school. She holds a BA in education from Michigan State University and has done post graduate work in educational counseling at Cleveland State University and Baldwin-Wallace College. She is a member of several local committees and task forces including the Lorain County (Ohio) Domestic Violence Task Force, the Lorain County Women's Forum on Human Rights, and the City of Avon ADA Advisory Committee. Nationally, she is the Regional Coordinator for Region 5 of the National Coalition Against Domestic Violence. Peg has a disability and has been legally blind since the age of ten. LEAP/Center for Independent Living is located in Elyria Ohio, twenty-five miles west of Cleveland, and offers services to all persons with disabilities who reside in two Ohio counties. The counties are a combination of urban and rural areas. The Center opened its doors in 1990, began an independent living program in 1991 and was officially recognized as a CIL in 1994. LEAP/CIL is dedicated to promoting the independent living philosophy for and the empowering of persons with disabilities. To that end, the center offers the core services of a CIL and, in addition, employment services. The center also offers a program, SWEAP (Services for Women with Disabilities Education and Assistance Program), which addresses the issue of violence and abuse in the lives of women with disabilities by raising awareness among local service providers, providing education on this subject and providing assistance to women with disabilities. Hillary Jane Colby graduated from the Jane Addams College of Social Work with a Bachelor of Social Work in May of 1998. She joined the staff of Access Living in January of 1999 as a domestic violence program coordinator. She currently serves on the board of the Chicago Metropolitan Battered Women's Network and the Women's Health Resource Center. She has made a personal commitment to addressing the unique issues faced by women with disabilities. In college, she became a leader in the disabilities advocacy program at her school. As a founder of the organization (Promoting the Rights of Individuals with Disabilities Everywhere), she set up long term goals for the group and helped to set into motion an annual disabilities awareness day. Under her leadership, P.R.I.D.E. helped to assess the school and the community for compliance with the ADA. She has been called upon to speak on disability related issues such as person first language, ADA compliance, the rights of persons with disabilities under the ADA, her personal experience with disability, and what advances have been made and where more work is needed. In 1994 she received the President's Award for Volunteers for her community involvement. Access Living was established to enhance the options of people with disabilities to live independently. Founded in 1980, Access Living was one of the first ten centers for independent living (CILs) in the United States. Over the last nineteen years, Access Living has grown from a small storefront organization with a staff of seven to a nationally recognized organization with a staff of more than forty. Access Living provides services to more than 2000 people annually, while more than 20,000 receive information and referral services only. We believe in the independent living philosophy that calls for community-based, consumer-controlled service and advocacy programs that emphasize a cross-disability and self-help approach. For many people, our organization is the bridge from dependence to independence. Each year even more people with disabilities are impacted indirectly by Access Living's community organizing, advocacy, and public education initiatives. Roberta E. Sick, M.Ed., L.P.C., C.R.C., panel moderator, is a trainer and consultant employed by the University Affiliated Program of Arkansas - University of Arkansas Medical Sciences. She has a master's degree in rehabilitation counseling and holds a professional counseling license and a rehabilitation counselor certification. Her work experience includes 20 years in the areas of personal counseling, advocacy, facilitating groups and training. She credits her work coordinating a clubhouse model program for persons with mental illness as helping her to understand the true meaning of empowerment and oppression. She provides training and consultation on a number of topics including the Americans with Disabilities Act, adaptations of toys for children with disabilities, the use of play as a tool to empower children, enhancing communication and conflict resolution skills. She is known primarily for her work as an entertaining trainer and as a group facilitator. She has most recently been involved in a project at the UAP that is funded through the Arkansas Commission on Child Abuse, Rape and Domestic Violence and is aimed at preventing rape and sexual assault of individuals with disabilities. University Affiliated Program of Arkansas, Little Rock, AR, is located within the Department of Pediatrics of the University of Arkansas Medical Sciences. The Arkansas UAP has affiliations with the University of Central Arkansas, the University of Arkansas at Fayetteville, Little Rock, Monticello and Pine Bluff. The mission of the University Affiliated Program of Arkansas is to support individuals with disabilities and the families of children with disabilities to fully and meaningfully participate in community life, effect systems change, and prevent disabilities. The program has five cornerstones: the interdisciplinary training of professionals; community training for local service providers, parents and consumers; creating exemplary services, supports and programs; providing technical assistance and sharing information gained from research. PRE-CONFERENCE DISCUSSION Terminology We have chosen to use the term abuse instead of violence in hopes that it will diminish any confusion on your part and eventually on the part of your consumers. The term violence is often associated with acts and behaviors that cause injuries or death; the term abuse encompasses these but can also include those that are less obvious and are more often experienced by individuals with disabilities. Abuse can be identified with behaviors like withholding money or medications, degrading the person and making fun of their body, etc. and can also involve acts like sexual assault, battery and restraining the person. Using terms like domestic violence with an individual with a disability will often bring to mind images of beatings, black eyes and murder. These images may not fit with the types of abuses they are experiencing, like being told they are worthless, not being allowed to see their family or friends or not being bathed or fed for days at a time. This confusion in terms, as well as the fear of losing their caregiver and the normalization oftentimes of abusive behaviors in the person's life, can make it difficult for the consumer to identify these behaviors as wrong. You may also notice that the different speakers in their presentation and in their handouts will use different terms regarding the individuals with disabilities that they serve. In the independent living movement, consumer is often the preferred term. In the field of domestic violence and abuse you will often hear the word client used. In our teleconference today, you will hear these words used interchangeably. Gender Issues of Abuse You will also notice that during this teleconference, references are often gender specific with women being mentioned more often than men. We are in no way diminishing the fact that men with disabilities are also the victims/survivors of abuse. However, most of the research and the majority of the victim/survivor service agencies are focused on women. It should be noted that men are less likely than women to disclose abuse, and they often have few options available to them for support or when they leave a domestic violence situation. In a 1996 Canadian study (Farm Family Health, 1998) it was found that it was as difficult for men and boys as it was for women and girls to admit that they were being abused and it was more difficult for them to find help after they did admit it. The patriarchal theory of abuse, the expectation for males to be tough and be able to protect themselves, and the lack of recognition to the different forms of sexual abuse contribute to the problem. The following are some examples of how gender plays a role in abuse:  Women are 10 times more likely then men to be victims of violent crimes in an intimate relationship. (Medical Strategies Inc., 1999)  The difference between abused men and abused women is primarily the severity of the physical injuries. Women are more at risk for severe or life threatening injuries. (Farm Family Health, 1998)  In the general population, 20% of females and 5%-10% of males are sexually abused every year in the United States. (Reynolds, 1997)  83% of women and 32% of men with developmental disabilities had been sexually assaulted (results of one study). (Sorenson, 1998)  According to the sexual assault statistics for Wisconsin in 1997, males committed 92% of offenses and 84% of the victims were female. 62.8% of assaults against males were committed by other males and 37.2% by females. Males committed 98% of assaults against females and other females committed 2%. (Wisconsin Coalition Against Sexual Assault, 1998.) A Word of Caution The content of this teleconference and material contained in this manual may trigger anxiety for some individuals who have or are experiencing abuse. We encourage anyone who is having difficulty with the content of this teleconference to seek support. Taking care of yourself is imperative to your ability to help others in similar situations. Just as independent living center staffs include many individuals with disabilities, sexual assault centers and domestic violence agencies are often made up of many individuals who themselves are survivors. If your interest in this field is based on personal experience, you are not alone. But it is important for you to be aware that you may be more vulnerable to these topics than someone who does not have the personal experience. If you need help as a result of the information covered in this teleconference, please call your local sexual assault or domestic violence agency. If you are unsure of the agencies in your area, you can call the National Domestic Violence Hotline at 1-800-799-SAFE (7233) (Voice) or 1-800-787-3224 (TTY) for the nearest domestic violence agency or 1-800-656-HOPE (4073) for the nearest sexual assault agency. Family Violence on the Farm, Farm Family Health, [On-line], Vol. 6. Available: http://hc-sc.Cox.ca/main/lcdc/web/publicat/farmfam/vol6-1/index.html Medical Strategies Inc., Healthtouch, Research and Statistics on Domestic Violence, [On-line], 1999. Available: http://www.healthtouch.com/level1/leaflets/ncadv/ncadv003.htm Reynolds, L. (1997). People with mental retardation and sexual abuse [On-Line]. Available: http://thearc.org/faqs/Sexabuse.html Sorenson, D. The Invisible Victims, 1998 [On-line], Available: Http://www.nvc.org/newsltr/disabled.htm Wisconsin Coalition Against Sexual Assault (1998). [Brochure]. Milwaukee, WI. SECTION II TELECONFERENCE OUTLINE I. Welcome and Overview - Roberta Sick from the University Affiliated Program, Little Rock, AR A. Teleconference Goals 1. Create awareness in independent living centers regarding abuse and individuals with disabilities. 2. Develop communication between independent living centers working on the issue of abuse. B. Introductions 1. Margaret Nosek, Ph.D., and Nancy Swedlund, Psy.D., from the Center for Research on Women with Disabilities, Houston, TX. 2. Leslie Myers from IndependenceFirst, Milwaukee, WI. 3. Debora Beck-Massey from Domestic Violence Initiative, Denver, CO. 4. Peg Calvey from LEAP/CIL, Elyria, OH. 5. Hillary Colby from Access Living, Chicago, IL. II. Learning Objectives and Questions to Panelists Learning Objective #1: Learn about the prevalence of abuse and the differences in the way abuse is experienced by individuals with disabilities. Question to Peg Nosek, Ph.D., and Nancy Swedlund, Psy.D., from the Center for Research on Women with Disabilities: Are women with physical disabilities abused more often than women without disabilities? If so, what would make a woman with a physical disability more vulnerable to abuse?  Our research indicates that the prevalence of abuse among women with physical disabilities is about the same as among women without disabilities.  Women with physical disabilities may have more difficulty escaping an abusive situation due to architectural inaccessibility or lack of access to their mobility devices.  Certain disability-related settings, such as hospitals, doctors' offices, and special transportation services may create a restrictive environment by separating women from their mobility devices, restraining them, or isolating them from others who could provide assistance, thus diminishing their ability to defend themselves.  For more information see Handout # 1 (pages 25-30). Question to Leslie Myers from IndependenceFirst: How does the legal definition of sexual assault and domestic violence need to be expanded in order to fully encompass the experiences of individuals with disabilities?  State laws will vary  Individuals with disabilities can be subjected to many types of abuses that people without disabilities are not.  Consumer story.  Found a need to re-word standard assessment questions.  Actual danger can be under-estimated if the right questions are not asked.  For more information on expanding the definition of abuse see Handout # 2 (pages 31-33). Question to Debora Beck-Massey from Domestic Violence Initiative: What are some of the complications that occur when abuse and disabilities occur together?  Legal system difficulties.  Not considered credible, especially if a mental illness is involved.  Speech and cognition difficulties add to this.  Often judged too rapidly. For other issues see Handout # 3 (page 34). Question to Peg Calvey from LEAP/CIL: What are some of the major concerns and difficulties your consumers with abuse history have expressed and faced?  Believability.  Healthcare.  Income (employability).  Finances (credit history).  Personal assistance.  Child custody.  Housing.  Transportation.  For more information, obtain a 1996 publication of the National Coalition Against Domestic Violence entitled "Open Minds, Open Doors Technical Assistance Manual: Assisting Domestic Violence Service Providers to Become Physically and Attitudinally Accessible to Women with Disabilities." Question to Hillary Colby from Access Living: Your agency has been working with abuse survivors for ten years, approximately how many people do you see per year and what long term effects does the abuse have on the individual?  Access Living's Domestic Violence program sees approximately 125 clients per year.  In addition, we receive hundreds of information and referral calls from victims, family members of victims, community members, and service providers.  One of the long term effects of violence against people with disabilities is an emergent need for services that is not met. We will attempt to help the victim escape the violence, but if they cannot access services they remain with the abuser. We may not hear from them for two to four months or until another acute incident.  The victims we see often have low self-esteem and a fatalistic belief that nothing they do will help.  Victims are often re-victimized by the legal and social services systems, as well as becoming potential targets for a new perpetrator. Learning Objective #2: Find out how to identify abuse and what to do if abuse is disclosed. Question to Peg Nosek, Ph.D., and Nancy Swedlund, Psy.D., from the Center for Research on Women with Disabilities: How can center for independent living staff identify women who are experiencing abuse?  Include questions about abuse on intake forms. The Center for Research on Women with Disabilities is developing an abuse screening instrument which may be useful for this purpose.  Display a poster about abuse of women with disabilities, including the phone number of the local abuse intervention program. This will give women the message that abuse is an acceptable topic to bring up.  Train Center for Independent Living staff on abuse issues so that they will be comfortable talking about this issue with consumers. Question to Leslie Myers from IndependenceFirst: Discuss how you deal with disclosures of abuse by your consumers?  Trauma Counselor, worked in a sexual assault and domestic violence agency.  Assess the situation.  Look at the person's immediate safety needs.  Developing an agency policy on disclosure of abuse can serve as a guideline.  Support system for staff.  Plan to spend time with the person who discloses the abuse.  Plan time for your own debriefing.  For further information on what to do when a disclosure is made see Handout # 4 (pages 35-39). Question to Debora Beck-Massey from Domestic Violence Initiative: What services does your agency provide to survivors who have disabilities?  DVI is a 501 C-3 founded in 1985; the founder, director, staff and board members are primarily people with disabilities.  Crisis intervention, emergency resources, peer support, education and awareness, resources, self-advocacy and mainstreaming clients into already existing services.  For information on what to look for as abusive see Handout #5 (pages 40-41). Question to Peg Calvey from LEAP/CIL: How do you identify consumers who have been or are being abused?  Creation of a trusting atmosphere and relationship.  Scheduling adequate time for intake interviews.  Asking leading questions: "How would you describe your home relationships?"  Observations for physical injury or certain behaviors.  For more information on identifying consumers who have been or who are being abused see Handout # 6 (pages 42-44). Question to Hillary Colby from Access Living: What are some of the things you have found helpful when a consumer discloses abuse?  Have resources posted and easily accessible.  Allow the client to determine how much they wish to disclose.  Give the client options but allow them to make the choices they feel are best.  When abuse is disclosed do not be judgmental about the past or current choices of the victim. Learning Objective #3: Offer ideas on how Centers for Independent Living can build supports and network with survivor services to insure access for individuals with disabilities. Question to Peg Nosek, Ph.D., and Nancy Swedlund, Psy.D., from the Center for Research on Women with Disabilities: How can independent living centers collaborate with survivor services to improve access to those services for women with disabilities?  Offer to train abuse intervention staff on disability issues, and encourage them to train center for independent living (CIL) staff on abuse issues.  Encourage abuse intervention programs to refer women with disabilities to the CIL for disability-related services, and encourage CIL staff to refer women who are experiencing abuse to the intervention programs.  Collaborate with the local domestic violence shelter to meet the special needs of women with physical disabilities who are in the shelter.  Loan of assistive devices.  Assistance in obtaining personal assistance care while in the shelter.  Finding accessible housing when the woman leaves the shelter. Question to Leslie Myers from IndependenceFirst: How have you been able to outreach to area abuse agencies? How receptive have these agencies been?  Began by working with the Wisconsin Coalition against Sexual Assault and also the Wisconsin Coalition against Domestic Violence.  Participated in local and statewide conferences.  Give inservices on disability issues.  Member of Coordinator Community Response team.  Working with three agencies on tracking individuals with disabilities accessing abuse services.  Many agencies have grants to do outreach to under-served populations.  Asked to help open a fully accessible shelter.  For further information on outreach see Handout # 7 (pages 45-50). Question to Debora Beck-Massey from Domestic Violence Initiative: Does your organization work with agencies that specialize in disability? How would your organization help other programs to include people with disabilities?  Advocating for the elimination of the physical and attitudinal barriers that lead to revictimization.  Serving as liaison between women with disabilities and the myriad of community agencies.  Fostering unity and growth through sharing experiences with others to reduce isolation.  Present training and technical assistance to service providers and the general community, as well as disability rights groups. Question to Peg Calvey from LEAP/CIL: What types of community education activities have you done that promote awareness of abuse in the lives of people with disabilities?  Three-hour awareness seminars for social workers and counselors.  Customized awareness training for nurses, law enforcement officers, home health care personnel and court personnel.  Participating in the training of new law enforcement officers in domestic violence procedures.  Teaching college students majoring in social work and human services.  For more information on community education see Handout #8 (page 51). Question to Hillary Colby from Access Living: How have you been able to outreach to area abuse agencies? How receptive have these agencies been? What steps has your agency taken when you encounter one of your community agencies that is inaccessible?  Join the state and local domestic violence coalitions.  Create networking agreements with service providers to ensure clients receive needed assistance.  Provide inservices and disability related training to service providers biannually.  Encourage service providers to be inclusive by hiring persons with disabilities as staff members.  Access Living has, at times, filed complaints with supervising agencies or their funding sources like the Department of Human Services.  The receptiveness of the domestic violence community depends on the strength of our staff members and our willingness to aid programs in determining how best to meet our clients' needs.  When Access Living finds an agency unwilling to become accessible or make reasonable accommodations there are several steps pursued with the consent of the client: phone calls on behalf of the client (if unsuccessful, find an alternative program); letter to the executive director of the program reminding them of their responsibilities under the ADA; making formal complaints to the local coalition; and, as a last resort, making a formal complaint to the funding source of that program. Learning Objective #4: Gain knowledge of three independent living centers that are addressing abuse issues, how they started and what they do. Question to Peg Nosek, Ph.D., and Nancy Swedlund, Psy.D., from the Center for Research on Women with Disabilities: What are some effective ways for center for independent living staff to advocate for consumers who are being abused?  Work with local abuse intervention programs to address accessibility problems.  Train other service providers, such as law enforcement and social service personnel, about the needs of women with disabilities who are experiencing abuse.  Help consumers address problems such as the need for alternative personal assistance care when the abuser has been providing that care. Question to Leslie Myers from IndependenceFirst: What steps has your agency taken to educate consumers on the issues of abuse?  Teaching classes on abuse.  Including information on vulnerabilities.  Including information on setting boundaries.  Including information on theories of domestic violence.  Including information on society's unwritten rules.  Including information on how the inequality of society increases our risk of abuse.  Teaching the class to disability groups outside of our agency.  Programs for Sexual Assault Awareness Week.  For more information on educating consumers about abuse see Handout #9 (pages 52-55). Question to Debora Beck-Massey from Domestic Violence Initiative: What provisions does your agency make for including individuals with disabilities into your programs? What things do we need to know to do?  Providing alternative forms of materials.  Including all forms of disability training to staff.  Self evaluation for more involved cases. Question to Peg Calvey from LEAP/CIL: Your program started after women in your support group kept bringing this abuse issue up. Tell us a little about that and the types of things they talked about.  Women's cross-disability support group, 1996-1997.  25 women, ages 18-55.  18 reported past or present abuse.  Family abuse by parents, siblings and children.  Caregiver abuse by home health care workers and therapists.  Partner abuse by spouse or significant other.  Creation of SWEAP in response.  For more information on the creation of the SWEAP program see Handout #10 (pages 56-57). Question to Hillary Colby from Access Living: In the ten years that your program has been running what are some of the things that have helped your program remain active including funding sources, outreach, etc.?  Consistent demand for services.  Staff members in the program who saw the need for the program.  Demand from the community of people with disabilities for services.  The continued support by the Illinois Attorney General.  For further information on Access Living's program see Handout #11 (pages 58-63). Learning Objective #5: Discuss the issues of accessing services and the sensitive nature of these activities. Question to Peg Nosek, Ph.D., and Nancy Swedlund, Psy.D., from the Center for Research on Women with Disabilities: What do you know about services in your community for survivors of abuse? Are these services physically accessible? Can they meet the needs of women with visual or hearing impairments? Is their staff trained on disability issues?  We have worked closely with the Houston Area Women's Center, which provides services to survivors of domestic violence and sexual assault.  The Women's Center facilities are physically accessible.  The Center has a counselor whose role is to work with women with disabilities who are being abused.  Disability issues are included in training for staff and volunteers. Question to Leslie Myers from IndependenceFirst: Discuss the ethical dilemma encountered when you are faced with the issue of reporting the abuse of a consumer to adult protective services vs. the independent living philosophy which promotes total consumer control, decision making, etc.?  Domestic violence and sexual assault agencies believe in consumer control.  Questions evolve when an individual with a disability may or may not be competent to make decisions.  Personal story.  No easy answers.  Should there be mandatory reporting of abuse when it occurs against individuals with disabilities?  Agency policy can help resolve dilemma.  For more information on ethical dilemmas see Handout #12 (pages 64-70). Question to Debora Beck-Massey from Domestic Violence Initiative: What are your state and/or community protocols that address the needs of a person with a disability or elders that are crime victims?  EWA Team.  Developed protocols to follow.  If community doesn't have protocols, then instigating a movement to create them with all players involved.  For example from protocol see Handout #13 (pages 71-72). Question to Peg Calvey from LEAP/CIL: What barriers have you faced when trying to help a person with a disability escape an abusive situation?  Slow delivery by Human Services entities.  Lack of community programs (i.e. drug and alcohol abuse).  Lack of funding for community programs and services.  Lack of accessible public transportation.  Lack of affordable and safe accessible housing.  Multiple oppressions. Question to Hillary Colby from Access Living: What steps does your agency take when you are working with a consumer who has a guardian? When it is the guardian who is the abuser?  We do not receive many requests for assistance by persons with a guardian.  When request like that comes in it is often a mandated elder abuse or child abuse case or a person in a group home setting who would receive assistance through the ombudsman's office. III. Questions from Participants IV. Presenters Closing Statements Margaret Nosek, Ph.D., and Nancy Swedlund, Psy.D., from the Center for Research on Women with Disabilities, Houston, TX.  Inform consumers about how to recognize emotional, physical, sexual, and disability-related abuse.  Include issues of abuse in all peer counseling, group support, independent living skills programs.  Inform rehabilitation professionals and medical professionals about abuse of people with disabilities and how it can interfere with the achievement of rehabilitation and health care goals. Provide them with a list of abuse referral resources.  Conduct awareness campaigns for consumers, service providers, medical professionals, and law enforcement personnel about abuse of people with disabilities and what can be done to stop it. Leslie Myers from IndependenceFirst, Milwaukee, WI.  Possibility that 33 to 83% of consumers have abuse histories.  Abuse-we can ignore or we can fight it.  Along with independence comes an increased risk of abuse.  Abuse does not have to be the price for independence.  Educating consumers, their families and society on the issues of abuse.  Advocating for the right of our consumers NOT TO BE ABUSED. Debora Beck-Massey from Domestic Violence Initiative, Denver, CO.  Care and get involved.  Colorado study showed that 85% of women with any type of disability had been victims of abuse as opposed to between 25 - 50 of nondisabled.  51% of the 54 million people with disabilities in the U.S. are women. Peg Calvey from LEAP/CIL, Elyria, OH.  Centers for Independent Living need to take active roles in addressing this "hidden" issue.  Centers for Independent Living can create programs for consumers and create community awareness.  Centers for Independent Living can become system advocates (VAWA as example).  Centers for Independent Living can build local partnerships (domestic violence task forces as example). Hillary Colby from Access Living, Chicago, IL.  Be aware that it often takes several attempts for a victim to leave their abuser.  Be prepared to see clients returning with the same issues.  Be as active in the domestic violence community as possible, as it will ultimately effect your client's outcomes.  Keep track of local, state, and national legislation that may effect your clients or your agency. Learning Objective #6: Know where to go for more information on these topics. V. Teleconference Closing Statement and Evaluation - Moderator - Roberta Sick from the University Affiliated Program, Little Rock, AR. SECTION III TELECONFERENCE HANDOUTS Learning Objective 1: Learn about the prevalence of abuse and the differences in the way abuse is experienced by individuals with disabilities. Handout #1: The following article provided by Margaret Nosek, Ph.D., and Nancy Swedlund, Psy.D., at the Center for Research On Women with Disabilities. Violence Against Women with Disabilities Findings from Studies Conducted by the Center for Research on Women with Disabilities 1992-1999 Supported by funding from the Centers for Disease Control and Prevention (R04/CCR614142), National Institute on Disability and Rehabilitation Research (H133A60045), and National Center for Medical Rehabilitation Research at the National Institutes of Health (HD30166). Introduction When we embarked on our initial study of women with physical disabilities in 1992, we intended to explore sexuality in its full range of meaning and experience. One of our advisors, Dr. Sandra Cole, strongly urged us to include questions about abuse in this study. To our great surprise, very high rates of abuse emerged as one of the most prominent findings of the whole study. Nearly two-thirds of the participants with disabilities and those without disabilities had experienced emotional, physical, or sexual abuse at some time in their lives. We took this as a mandate from the more than 1,000 women who participated in the study to delve deeper into the causes and solutions to this problem. In listening to the stories of the women in our study, we began to understand that there are at least three sides to the problem of abuse. First and foremost, it is a very personal problem of the woman as an individual. Her ability to recognize her experiences as abusive, seek help, protect herself, remove herself from the abusive situation, or discover some other way to resolve the abuse, are all very much affected by her disability and the limitations imposed by barriers in her environment. Second is the role of disability-related service providers. In the broad spectrum of social, vocational, and medical services available to women with disabilities, abuse is rarely detected or addressed. Third is the availability of services from battered women's programs, which only recently have begun to appreciate the importance of making all their services and facilities accessible to women with all types of disabilities. We have been very fortunate to receive funding to continue our investigation of abuse issues on all three of these dimensions. The National Center for Medical Rehabilitation Research at the National Institutes of Health funded the initial study, which yielded a wealth of data from personal interviews and a national survey about the lives of women with physical disabilities. The National Institute on Disability and Rehabilitation Research at the U.S. Department of Education funded our examination of the systems' response to abuse of women with disabilities, particularly by rehabilitation counselors, independent living centers, and battered women's programs. The Centers for Disease Control and Prevention is funding our study of strategies to identify and assist abused women with disabilities, and examine the effect of abuse on secondary disabling conditions. This research has only begun to identify the dynamics of abuse in the lives of women with disabilities. Much remains to be done in determining the most effective methods for helping women with disabilities eliminate abuse from their lives and training service providers on how best to assist women in their journey. We present the results of our work to date in the hope of planting seeds for change and sparking interest among those who would bring about this change in their own domain. Margaret A. Nosek, PhD Principal Investigator Carol Howland Project Director Rosemary B. Hughes, PhD Project Director Mary Ellen Young, PhD Catherine Clubb Foley, PhD Laurie Walter, PhD Nancy Swedlund, PsyD Ellen Grabois, JD, LLM Kym King With grateful appreciation for our support staff Kathy Meroney Nancy Womack Graciela Wright Joyce White And our consultants: Janet Y. Groff, M.D., Dr. P.H. Judith McFarlane, R.N., Dr. P.H., FAAN Patricia D. Mullen, Dr. P.H. Center for Research on Women with Disabilities Department of Physical Medicine and Rehabilitation Baylor College of Medicine 3400 Richmond, Suite B Houston, TX 77046 713-960-0505 (V/TTY); 713-961-3555 (Fax); 1-800-44-CROWD (1-800-442-7693) Email: crowd@bcm.tmc.edu URL: www.bcm.tmc.edu/crowd The Personal Side of Abuse Both women with disabilities and women without disabilities experience very high rates of emotional, physical, and sexual abuse; however, women with disabilities are more likely to experience abuse at the hands of a greater number of perpetrators and for longer periods of time.  About the same percentages of women with and without disabilities reported emotional, physical, or sexual abuse in their lifetimes (62%). About half (52%) reported experiencing physical or sexual abuse. Thirteen percent of women with physical disabilities described experiencing physical or sexual abuse in the past year.  Women with physical disabilities and women with no disabilities were equally likely to have experienced abuse during childhood.  The most common perpetrators were intimate partners or members of the family of origin. Women with disabilities were more likely than women without disabilities to experience abuse by health care providers and attendants. Women with disabilities were abused by a greater number of perpetrators than women without disabilities.  Women with physical disabilities were more likely to experience more intense patterns of abuse over their lifetimes than women without disabilities. In addition to the types of abuse experienced by women in general, women with disabilities experience some types of abuse that are specifically disability-related.  Disability-related emotional abuse takes the form of emotional abandonment and rejection, threats, denial of disability, accusation of faking, belittling, and blaming.  Disability-related physical abuse takes the form of physical restraint, confinement, withholding use of orthotic devices or medication, and refusing to provide assistance with essential personal needs, such as toileting, hygiene, and eating.  Disability-related sexual abuse takes the form of demanding or expecting sexual activity in return for help, taking advantage of physical weakness, and using an inaccessible environment to force sexual activities.  Certain disability-related settings, such as hospitals, doctors' offices, special education classrooms, and special transportation services may create a restrictive environment by separating disabled children and adults from their mobility devices, restraining them, or isolating them from others who could provide assistance, thus diminishing their ability to defend themselves.  The need for personal assistance and the difficulty of locating and retaining persons, either within or outside the family, to provide that assistance make women with disabilities more tolerant of abusive behaviors.  Traditional screening questionnaires for determining abuse prevalence are not sensitive to abuse that is specifically disability-related. The Systems' Response to Abuse A very small percentage of women with disabilities who are being abused are able to receive services from a battered women's program.  Our survey of 598 battered women's programs showed that they vary widely in the number of women with disabilities that they serve, but the most common number was 20 women with disabilities served in the past year. These were primarily women with mental illness. Programs were least likely to serve women with visual or hearing impairments. For nearly half the programs, less than 1% of the women served had physical disabilities.  Of these programs, 83% offered referral to accessible shelters or safe houses and 47% provided sign language interpreters for women with hearing impairments.  Only 35% of these programs offered disability awareness training for their staff. Only 16% had a staff member who was specifically assigned to provide services to women with disabilities.  49% of the programs reported that the most effective outreach service for making women with disabilities aware of their services was community presentations and training, but only 16% offered such outreach services. Rehabilitation counselors rarely ask their clients about problems with abuse, although they acknowledge that abuse can interfere with the achievement of rehabilitation goals.  75% of rehabilitation service providers were aware of the importance of the problem of abuse of women with disabilities. 95% indicated that abuse of a woman with a disability interferes with her vocational or independent living goals.  75% believed they could recognize the signs of abuse. 74% indicated they were comfortable responding to abuse issues. 91% knew where in the community to refer women with disabilities who have experienced abuse. 80% believed it was within their job responsibilities to deal with their clients' abuse issues.  In spite of these high percentages of responses indicating a knowledge of and confidence in dealing with abuse issues, only 19% of the survey respondents indicated that they routinely ask their clients about abuse. Independent living centers (ILCs) can be an initial point of contact for women with disabilities experiencing abuse.  Most of the 41 ILCs that responded to our survey thought the most effective approach for them to address abuse of women with disabilities was a strong collaborative relationship with local abuse intervention programs, such as domestic violence shelters and sexual assault programs.  The service that ILCs offered most frequently was referral to local abuse intervention programs. ILCs have worked with these programs to improve their accessibility and responsiveness to women with disabilities. They have also helped to provide personal assistants to women who are in shelters or who need respite care due to an abusive care provider.  Many of the ILCs in the survey were addressing abuse issues through their individual and group counseling services.  ILC staff sometimes offer to train staff of abuse intervention programs on the needs of women with disabilities, and invite abuse program staff to train CIL staff on abuse issues. Conclusion These findings reveal the substantial need for information and training on abuse issues for service providers regardless of their work setting. In order to address the issues of abuse and violence in the lives of women with disabilities, all service providers should: 1. Know about the issues of sexual assault and family violence, and be able and willing to assist their clients with safety planning. 2. Know the resources in their community for dealing with abuse experiences. 3. Form linkages with abuse intervention programs and victim assistance providers. 4. Include abuse screening as a routine part of their client intake and follow-up procedures. 5. Provide information, resources, and referrals to clients who are in abusive situations or who have experienced abuse in their lives. For women with disabilities, we offer the following heartfelt advice for removing violence from your lives: 1. You are a woman of value and you deserve to be treated with respect, dignity, and courtesy at all times and in all situations. You do not cause the abuse. You have a right to live without threats, humiliation, or isolation. You have the right to make your own choices. 2. Physical and sexual abuse are crimes punishable by law. You have the right to report criminal abuse to law enforcement authorities and receive due process of law. 3. Plan for your own safety by: a. Having a bag packed and hidden with money, copies of house and car keys, copies of important documents (birth certificate, Social Security card, immigration documents, identification card, driver's license), spare assistive equipment, prescriptions, medical supplies, and changes of clothing. b. Preparing for personal assistance from someone other than your abuser and making arrangements to stay with friends or family during a transition. c. Getting a post office box in your name and hiding the key. d. Opening a savings account in your name only and having benefit and other income checks deposited directly into it. 4. When you sense you are in danger, GET OUT! Services are available to help you find shelter and deal with abusive situations and relationships. Ask your local battered women's program, independent living center, rehabilitation counselor, or social service agency about how they could help you. Make your disability-related needs known to them and ask for accommodations that would help you gain more benefit from their services. 5. Talk to other women with disabilities about abuse. They may share your experience and benefit from hearing some of the solutions you have found. By breaking isolation, you can break the cycle of abuse. For a list of articles explaining the studies that generated the statistics cited above and for a list of training materials on abuse interventions, contact the Center for Research on Women with Disabilities at 1-800-44-CROWD or on the Internet at www.bcm.tmc.edu/crowd. Handout #2: The following materials are provided by Leslie Myers at IndependenceFirst. It is estimated that the instances of abuse of women with disabilities ranges from 33% to 83% depending on the type of disability and the definition of abuse (Schaller and Lagergren, 1998). In 1987 the DisAbled Women's Network (D.A.W.N.) of Canada conducted a survey of 245 women with disabilities and found that 40% had been abused and 12% had been raped. Perpetrators of the abuse included spouses and ex-spouses in 37% of the cases, strangers in 28%, parents in 15%, service providers in 10% and dates in 7%. The number of women and girls who have been raped in their homes, in institutions or on the streets is hard to estimate. It was found that women in long-term rehabilitation facilities were sterilized without permission to hide the molestation that occurred within the institutions. In 1984, the California community care facilities for the physically and mentally disabled and the elderly were investigated and it was found that residents were being sexually abused and beaten on a daily basis throughout the stateb (Asch and Fine,1988). Over-protection and limited information fosters over-compliance, socialized vulnerability and limited social opportunities for women with disabilities. It also limits the opportunities for women with disabilities to learn their sexual likes and dislikes, as well as the development of the communication skills necessary for setting boundaries. Women may, as a result, act on opportunities for relationships and sexual experiences out of the fear that the opportunity may not present itself again or simply because they desire normalcy. Women with disabilities may be poorly prepared for dangerous situations, surprised when threatened and ill equipped to protect themselves (Schaller and Lagergren, 1998). Women with disabilities are at an increased risk of abuse because there may be an impairment of the abilities that are critical for self defense or the avoidance of violence, they may be more socially isolated because of their disability, they may be dependent on others for their care, negative attitudes towards individuals with disabilities fosters violence against them, possible placement in institutional care and the discriminatory practices in violence prevention and law enforcement (Dell Orto and Marinelli, 1995). Expanding the Definition of Abuse While the state laws that define sexual assault and domestic violence will vary, the actual behaviors that are classified as abusive remain fairly consistent. Physical abuse includes behaviors like hitting, slapping, kicking, burning, pushing, shoving, punching, choking, using a weapon and/or destroying loved objects or animals. Emotional abuse includes humiliating the person; calling them names; constant harassment; forcing them to become isolated from family, friends and other outsiders; jealous accusations; guilty accusations; disrupting the person's sleep and/or playing with their perceptions of reality. Sexual abuse includes rape, making fun of the person's body, making them perform sex acts that are humiliating, making sexual threats, sexual harassment and/or threatening to sexually abuse the person's children. Economic abuse includes withholding money from the person, lying about financial matters, ruining the other person's credit and/or stealing their money. Children can also be used as a weapon between parents. Some of these abuses include using the children as spies, threatening to hurt or kill the children if one parent leaves, threatening to kidnap the children, blaming one parent for children's problems, accusing them of ruining the children's lives and/or the sexual or physical abuse of the children which the parent is unable to stop. Individuals with disabilities can be subjected to abusive behaviors that people without disabilities are not, making it necessary to expand the definition of abuse. These abuses are the result of the type of contact that is required between a caretaker and the individual with a disability, such as bathing, feeding or meal preparation, dressing, etc. This type of contact is usually not needed between partners that do not have special needs. Some examples of these unique abuses include:  Withholding medication.  Withholding personal care services.  Withholding needed medical equipment like walkers, canes, wheelchairs, etc.  Causing physical pain during routine dressing or bathing (i.e. yanking the person's arms to cause pain while taking off the individual's shirt or dropping the person while transferring them in and out of tub).  Physically restraining the individual.  Keeping them from contacting outside agencies (i.e. independent living centers, respite care, etc.).  Keeping them from receiving needed benefits (i.e. SSDI, personal care attendant services, etc.)  Refusing to fix meals or feed the person.  Making the individual lie in their own waste or remain unwashed/bathed.  Withholding benefits/money or controlling the person's finances. This list only touches on the many possible abusive situations that an individual with a disability may face at the hands of a caretaker or family member. With this list we hope to help you begin identifying the consumers you are working with who may be at the greatest risk of being abused. SOURCES Asch, A, & Fine, M. (1988). Introduction: Beyond pedestals. In M. Fine & A. Asch (1988). Women with disabilities: Essays in psychology, culture and politics (pp. 1-37). Philadelphia, PA: Temple University Press. Cusitar, L. (1994). Strengthening the links: Stopping the violence. Toronto: The DisAbled Women's Network (DAWN). Dell Orto, A.E. & Marinelli, R.P. (Eds.) (1995). Encyclopedia of disability and rehabilitation. New York: Simon and Schuster MacMillian. Myers, L.A. (1999). Serving Women with Disabilities: A Guide for Domestic Abuse Programs. Milwaukee, WI: IndependenceFirst. Myers, L.A. (1999). Working with Abuse Survivors: A Guide for Independent Living Centers. Milwaukee, WI: IndependeceFirst. Schaller, J. & Lagergren Frieberg, J. (1998). Issues of abuse for women with disabilities and implications for rehabilitation counseling. Journal of applied rehabilitation counseling, 29 (2), pp. 9-17. Handout # 3: The following material is contributed by Debora Beck-Massey from Domestic Violence Initiative, Denver, Colorado. Domestic violence is the most widespread, most under-reported crime in America. Ninety-two percent of respondents rated abuse and violence as their number one issue. The judical system, psychological factors, and limited resources for shelters and counseling have prevented women from receiving the kind of help they need and deserve. While public awareness of the issues involving domestic violence has recently grown, the issues unique to women with diabilties who are in domestic violence situation remain hidden. Women with disabilities are less likely to report abuse because they often  Have limited job opportunities and lack the means with which to support themselves independently;  Lack shelter, housing options, or transportation;  May experience extreme isolation fostered by society's attitudes of segregation;  And because the experience of having a disability significantly impacts their ability to become and remain socially and economically independent. (OVC Bulletin.) Office for Victims of Crime (September 1998). Office for Victims of Crime Bulletin. U. S. Department of Justice Available: http://www.ojp.usdoj.gov/ovc/factshts/disable.htm Learning Objective 2: Find out how to identify abuse and what to do if abuse is disclosed. Handout #4: The following materials provided by Leslie Myers at IndependenceFirst. Working with Survivors of Abuse The following information is being provided as a guideline. You should remember that each individual is different and their experience of abuse is unique. When you begin working with survivors you may find your own ways to approach the individual, and we encourage you to use whatever style works for both you and your consumer. Starting the conversation can be the hardest part of talking to someone you think is being abused. Remember, a controlling partner/caregiver blames the other for the abuse, so any questions about the person's actions, background or personal life may be heard as accusations by the individual and these questions may ultimately silence the person. The very first conversation will be hard, but in order to help you must first begin. Be sure that you have privacy and allow enough time to let the person talk at length if he/she wants to. It is helpful to say the obvious: "You seem unhappy, do you want to talk about it? I would like to listen and I will keep it just between us." If the individual rejects your offer, your observation about their unhappiness will at least validate some of their feelings and has left a door open for them to approach you for a confidential conversation in the future. Some sample questions that you may find helpful if the previous approach does not work or if the individual is having difficulty getting started include some broad questions: What is it like for you at home? What happens when you and your partner/caregiver disagree or argue? How does your partner/caregiver handle things when he/she does not get his/her way? When the person becomes more comfortable and is ready and willing to talk about things, you can ask more specific and direct questions: Does your partner/caregiver put you down? Call you names? Yell at you? Punish you in any way? Does your partner/caregiver ever push you around? Hit you? Does your partner/caregiver ever make you have sex? Do sexual things that you do not like? These are only a few examples of how to begin working with a consumer who is also a survivor. It is important for you to convey to the consumer that you are willing to listen, and this may be all that is needed for you to provide an atmosphere that is safe for them to talk about the abuse in their life. Many people will talk if they feel safe. You can help them to feel safe by assuring confidentiality. When the person is telling their story, listen and do not interrupt. Do not let your body language convey messages of doubt or judgment. If the person is having trouble talking, you can ask them how you can help. Let them know that you care and that there are people and agencies that can help. If the person refuses to talk or says "no" to your offer of additional help, the person has their own reasons for doing so and these reasons should be respected. Express your concern anyway and let them know that any type of abuse is wrong and that they deserve better. Leave the door open and assure the person that you will be willing and ready to talk if he/she asks (KASA and Domestic Violence Project). Similar to the independent living philosophy of consumer control, domestic violence agencies believe in giving the person choices of whether or not they want to talk about the abuse, report the abuse to the police or leave the abusive relationship. No one should be forced or coerced into discussing abuse issues because this would put the person trying to help in the same position as the abuser. Giving the individual the choice of whether or not they want to accept your help may be the first time they have had an opportunity to make a decision on their own. It gives the person back power and control over their own life. Conveying the message that the person has power and control in this aspect of their life is the first step in helping them to become empowered. Often individuals with disabilities are told at an early age that they are worthless or undeserving of love. A person subjected to this over a long period of time is likely to have a low self-esteem. Anyone living in an abusive relationship will often internalize the negative messages sent by the abuser. Abusers continue to take away the person's self-esteem and power and control and it is important for you to give these back to them. If you take control over the person's decisions (which the person may let you do because this is what they have known and lived with), you will be taking away the opportunity for growth and empowerment, as well as allowing the person to remain in the victim "role". To help the "victim" of domestic violence become a survivor, remember to:  Give the person control over what he/she does and talks about.  Give the person the power to make his or her own decisions.  Let the person lead your conversations.  Help the person to identify and acknowledge their strengths.  Encourage and applaud even the small steps the person may make in taking control over their life.  Stand by the person even when the decisions or actions he/she makes are not those you think would have been best.  Do not blame the person for the abuse and remind the person often that the abuse is not their fault.  Educate the person about abuse, why it happens, agencies that are available to help and what he/she can do.  Assure the person that he/she is not alone.  Let the person know that he/she has nothing to be ashamed or embarrassed about. When a person tells you they are being abused, you should:  Believe the person, they have no reason to lie to you about the abuse. Many people who need to have control over others are charming and gracious to outsiders, so what you see of their behavior may be deceiving. Even if what the person is telling you seems incredible, listen to their story and respect how it is being told. Abuse is painful to experience and the individual may recall details slowly and in fragments.  Acknowledge and support the person for talking. They took a risk that their partner will hurt them or that you will reject them, so let the person know you appreciate what they have done.  The person may be frightened, confused, angry, sad, numb, hopeless, etc. Assure the person that the person's feelings are normal and reasonable.  Let the person take the lead in the conversation. They need you to be a good listener.  If you cannot or do not want to do something the person asks you to do, talk it over and try to find another way of meeting that need. Do not impose your ideas of help onto the person.  Let the person know that you care about them and their safety. Take the person's fears seriously. Express your concern with statements like, "I think you are in danger and I am worried about your safety."  Do not blame the person for the abuse and let them know it is not their fault. Remember that the person's feelings about their partner are confused and mixed and if you express too much anger at the partner they may feel the need to defend him/her.  Offer to help the person find resources for protection and advocacy or support (do not offer what you can not deliver). Offer to go with the person to an agency or shelter if they want to go. Encourage the person to get more support and information, give the person newspaper articles, books and pamphlets that are put out by the local shelter.  Let the person go at their own pace and be patient. No one decides to give up a relationship overnight. Remember that the person may be facing threats and an escalation of the violence during the time he/she is planning to leave. Help the person to make plans, but let the person make the decisions. Seek the advice of abuse experts in your community as you are making plans.  Do not treat the person like a child or as a helpless victim. Remind the person of the their strengths, positive attributes and accomplishments.  Support the person's actions.  Do not assume the police, courts and other agencies will protect the person. Many communities don't protect women's rights or the rights of individuals with disabilities. Do not be surprised if they choose to take no action because it seems safer. Do not mistake this decision for passivity or indifference. Find the help that is available in your community and offer to take the person's side with these agencies, as well as their family and friends. Attempt to find legal advocacy in your area.  Help the person expand their support system (if they want you to). Provide them with a list of support groups held at local shelters, women's centers or other agencies and encourage them to join. Enlist the person's co-workers or friends to help with childcare or to go to court with them. Having support will help the person become stronger (KASA and Domestic Violence Project). The following list is some dos and don'ts for working with survivors of abuse: DO'S  Give the person your full attention, take your time and mind your manners.  Allow the person to tell their story without interruption or pressure and respect the person's space.  Repeat or rephrase what was said and ask questions in order for you to fully understand what is being said.  Help the person identify and understand what they are feeling.  Be aware of your own attitudes, experiences and reactions.  Take into consideration the individual's cultural values and beliefs.  Challenge any negative attitudes the person has toward himself or herself. Help them find their good qualities and acknowledge their worth and value.  Challenge any attempts to justify the abuse. Question any religious and/or social reasons the person may give to justify the abuse.  Maintain confidentiality.  Communicate what the person can and cannot expect, focus on the most pressing issues, be realistic about options and know your agency's' policies and limits.  Attempt to communicate trust, support and confidence.  Realize that you may never know whether the person follows through with your recommendations.  Always remember that it is the person's choice of what she or he will do.  Remain calm and clear-headed. DON'TS  Don't make the person's crisis your crisis.  Don't tell the person how he or she is feeling or what he or she is going through.  Don't order the person to do anything. You can offer suggestions, but it is up to the individual to decide what course of action is best for her or him.  Don't criticize or judge the person's culture or class.  Don't allow yourself to become personally involved with the person. They need you to remain a professional confidant and support person more than for you to become their "friend".  Don't be unrealistic about other issues the person may be facing, such as drug and alcohol abuse, homelessness, mental illness, child abuse, stealing, lying and other people.  Don't become discouraged if you are unsuccessful; you can only offer advice. It is ultimately up to the individual to follow through with his or her plans (KASA and Domestic Violence Project). Material from the Kenoshans Against Sexual Assault (KASA) and the Domestic Violence Project training manual were reproduced with permission. SOURCE Kenoshans Against Sexual Assault (KASA) and Domestic Violence Project, Training Manual, Kenosha, WI. Handout # 5: The following materials are contributed by Debora Beck-Massey from Domestic Violence Initiative, Denver, Colorado. All Women Face Barriers PERSONAL: shame, fear, lack of personal resources, lack of emotional support RELATIONSHIP: denied access to money, transportation, jobs, physical abuse INSTITUTIONAL: immigration policies, cultural insensitivity, lack of services, discrimination, sexism, other forms of oppression CULTURAL: language differences, beliefs about marriage and family, gender roles, religious beliefs, disabiliphobia What to look for: 1. Couple avoids being around others, preferring to stay at home or to go out alone. 2. One person appears to do the decision making for both people. 3. The couple avoids discussing the relationship or focuses on only the good qualities and avoids discussing problems. 4. One person exhibits quick and inappropriate behavior. 5. One person seems to be blamed for causing all the problems in the relationship. 6. Abuse, such as yelling or name calling, is openly observed and marks or bruises may be visible. 7. One partner exhibits obsessive jealousy toward the other and may accuse the other of infidelity. 8. The couple openly experiences intense and sometimes violent arguments. 9. One partners tries to isolate the other from significant others and may sabotage friendships to prevent the other from receiving support. 10. Batterer is secretive about past. 11. One partner's needs are more important than the other's. 12. Partner refuses to leave the other's presence when at doctor's office, hospital, often under the pretence of caring. Behavioral Indicators of Abuse  Thoughts about or attempts at suicide  Depression  Alcohol or drug use  Appears frightened, nervous, withdrawn, ashamed, evasive or embarrassed  Accompanied by partner, who insists on staying close and answering all questions  Seems reluctant to speak or disagree in front of partner  Intense, irrational jealousy or possessiveness is expressed by partner or reported  Either denies or marginalizes violence  Exhibits an exaggerated sense of personal responsibility for the relationship including self-blame for partner's violence.  May appear to be in noncompliance with medical regimen prescribed for a chronic condition. How to Help  Allow her to tell her story, at her own pace.  Let her know you believe her and want to hear about her experiences.  Help her identify her feelings.  Support her right to be angry. Don't deny her feelings.  Be sensitive to the differences between women. No woman is a stereotype and each has a different life experience.  Respect the cultural values and beliefs that may be a source of security for her. Their importance to her should not be minimized.  Know that she does not need rescuing.  Help her assess her own resources and support systems. Working with Battered Women with Multiple Oppressions  By ensuring that residential program make available a variety of hair and skin care products, as well as a diversity of food, to meet different cultural, religious, and health standards.  By including policies on discriminatory violence, along with policies on physical violence, and by enforcing these policies.  By providing referral and advocacy for women whose medical care needs preclude their use of shelters.  By making available literature and periodicals which represent the interests of a diverse group of women.  By working to provide services to women with similar concerns, i.e. older women and battered lesbians.  By recognizing and planning for special safety needs (i.e. lesbians in shelter are not automatically safe under "no male" policies. Additional screening may be necessary to ensure that female perpetrators do not enter shelter.)  By showing sensitivity and respect for women's decisions to disclose information about themselves to other women in groups and shelters and by never disclosing information about a woman without her permission. Handout #6: The following materials provided by Peg Calvey at LEAP/CIL Definitions and Indicators of Abuse Emotional Abuse is being threatened, terrorized, corrupted, rejected, or ignored. Some examples are: Deliberate embarrassment Belittles disability Threatened with loss of children because of disability Threatened with being institutionalized Denial of phone usage Threatened with withholding personal assistance Some indictors are: Isolation Stress or stress related illness Excessive worrying Distrust of others Constantly criticizing others Emotional outbursts Financial Abuse is the deliberate denial or withholding of the means to financial independence. Some examples are: No personal money Forced to write bad checks No access to checkbooks or savings Not encouraged to seek work No control of own benefit payments Some indictors are: No money Malnourished Broken or missing assistive devices No checking or savings accounts in own name Lack of personal belongings Physical Abuse is any violence against the body. Some examples are: Pushing Withholding assistive devices Withholding medications Punching Dragging Burning Shoving Some indictors are: Bruising Bruising in shape of familiar object Small burns Sprains Malnourished Skin breakdowns Assistive devices in poor repair Assistive devices not available Sexual Abuse is being forced, threatened or deceived into sexual activities. Some examples are: Rape Unwanted sex acts Withholding sex Forced pregnancies Constant sexual demands Withholding birth control Derogatory remarks about body Some indictors are: Genital pain Bleeding or bruises Difficulty walking or sitting Bruises on inner thigh Verbal Abuse is being subjected to repeated, deliberate and degrading verbal assault. Some examples are: Yelling Nagging Makes fun of disability Racial slurs Cursing Name-calling Denigrating women Some indictors are: Crying easily Loss of sleep Moody Hyper-alert Checklist for Creating a Supportive Consumer Intake Environment  Private interview space available and used?  Sufficient time allotted (minimum two hours)?  Refreshments available (coffee, tea, soft drinks, etc)?  Consumers assured of confidentiality?  Staff gender matched with consumer gender?  Asked leading questions such as "How would you describe your home relationships?" "Do you feel respected at home?" "Are your caregivers providing all the services you need?"  Appropriate consumer feelings and emotions affirmed?  Active listening skills used? Learning Objective 3: Offer ideas on how Centers for Independent Living can build supports and network with survivor services to insure access for individuals with disabilities. Handout #7: The following supplemental materials are provided by Leslie Myers at IndependenceFirst. Disability Education-Inservice for Victim/Survivor Agencies Outline I. Disability Etiquette a. Politically correct language b. Stereotypes and myths II Mobility Impairment a. Tips (i.e. sitting at eye level with someone in a wheelchair when talking to them for long periods of time, never grabbing the person's wheelchair or other assistive device, let person keep devices within their reach, etc.) b. Stereotypes and Myths III. Blindness and Visual Impairment a. Tips (i.e. speaking to the person as you approach them, identifying who you are and anyone else in the room, being descriptive when giving directions, etc.) b. Stereotypes and Myths IV. Speech Impairment a. Tips (i.e. don't pretend you understand what was said if you don't, talk directly to the person not to their companion or interpreter, never complete the person's sentences, etc.) b. Stereotypes and Myths V. Deafness and Hearing Impairment a. Tips (i.e. talk directly to the person not to the interpreter, speak at a normal volume, get the person's attention by tapping them on the shoulder before beginning to talk, keep your hands away from your mouth and speak in short sentence for individuals who lip read, etc.) b. Stereotypes and Myths VI. Title III of the Americans with Disabilities Act (ADA) a. Agency requirements under ADA. b. How independent living centers can help. VII. Transportation issues in receiving services or leaving abusive relationship a. Accessible public transportation-not available everywhere. b. Specialized transportation-requires 24-hour notice. c. Accessible taxi services-not available in all areas, often require advanced notice. d. The problems with transportation exacerbate the isolation issues seen in domestic abuse situations. e. Need for alternate solutions to problems with transportation. VIII. Accommodations a. Telecommunication Device For The Deaf- TDD b. Interpreters c. Written materials available in Braille, large print, audiotape, etc. d. Physically accessible facilities e. Need for staff with experience in disability issues and assessing person's needs at initial contact (i.e. disability screen) The disability screen that follows is being used by both sexual assault and domestic violence agencies to track the numbers of individuals with disabilities they are seeing. The sexual assault/domestic violence screen is being used by IndependenceFirst as part of our intake process and follows the disability screen. Both of these screens can be duplicated and/or altered to fit your agencies needs as long as proper credit is given to IndependenceFirst. Disability Screen 1. Sex? M ______ F ______ 2. Age? 3. Disability? (check all that apply) Psychiatric Disabilities Depression/Manic Depression Anxiety Disorder Schizophrenia Alzheimer's/Dementia Personality Disorder Sleep Disorder Eating Disorder Adjustment Disorder Somatoform Disorder Psychotic Disorder Psychiatric Other Physical Disabilities Spinal Cord Injury Post-polio Multiple Sclerosis Muscular Dystrophy Arthritic Conditions Chronic Fatigue Limb Loss/Amputation Fibromyalgia Head Injury Stroke Diabetes Asthma/Respiratory HIV/AIDS Heart Disease/Conditions Cancer Multiple Chemical Sensitivity Neurological Chronic Pain Orthopedic Substance Abuse/Addiction Physical Other Sensory Disabilities Deaf/Hard of Hearing Blind/Visual Impairment Deaf and Blind Sensory Other Developmental Disabilities Mental Retardation Down's Syndrome Cerebral Palsy Epilepsy/Seizure Disorder Spina Bifida Autism Learning Disability/Attention Deficit Disorder/Hyperactivity Disorder Developmental Other Number:_____(Office use only) ADDED NOTE: In keeping with the ADA, caution should be used when any type of disability screen is collected or used for data purposes. We encourage you to insure that you follow applicable laws as you collect data. A disability screen is probably okay as long as it is only a tool for tracking statistics of persons served. As you can see, this form has no place for a name to identify the person completing the form. Many CILs typically track disability type because there are federal reporting requirements with which they must comply. This becomes more problematic for organizations not required to do such tracking, for example, domestic violence service centers. An organization not required to do such tracking would need to go to great lengths to ensure that the information would be collected in such a way as to not allow bias, or the appearance of bias, in providing services. Some of these might be: A. You would need to document a legitimate need. In other words, if you collected the information, but never produced reports or produced reports for which you had no need, this would call into question the need to collect information. B. You might do well to completely separate the disability-related information from other service files, perhaps going so far as to have the person completing the screen (the client) place the completed form in a sealed envelope which would be opened later by another staff member not familiar with or involved in the intake process. C. Remove any coding numbers from the form, which could be linked to other records. If the form were to be used in serving the consumer, there would have to be a very good, clear reason for requesting disability information and for maintaining the information on file with the individual's records. That reason would need to be directly related to service delivery and supports. Even considering all of the above cautions, any organization collecting the disability information would want to question themselves before they open themselves up to possible charges of discrimination. Keeping the information in any manner other than statistical records in which no names are identified seems to be an invitation for problems. These cautions should be considered should you wish to use a disability screen. Domestic Violence/Sexual Assault Screen 1. Sex? M _____ F ______ 2. Age? 3. Disability? 4. Have you ever been physically hurt by another person? Y N PHYSICAL ABUSE: includes any intentional violence against your body including: being hit, kicked, restrained, pushed, etc.; the withholding of care including: denied food, water, mobility aids, medications, personal care (bathing, changing your clothes, allowing you to lay in your own body waste, etc.), etc.; intentional rough/hurtful handling including: dropping you during transfer, causing pain in your arms, legs, head and/or torso during bathing, dressing or transferring, etc.; any intentional actions done by another person that cause you physical pain. 5. If yes, at what age(s)? , for how long or how often? by whom? 6. Have you ever been emotionally hurt by another person? Y N EMOTIONAL ABUSE: includes being threatened, verbally attacked or terrorized; rejecting, ignoring, corrupting, teasing you (making fun of you, calling you names, talking about you to another person like you were not present), etc.; stealing money or other items from you; isolating you from friends or family, etc.; any intentional actions done by another person that cause you emotional pain. 7. If yes, at what age(s)? , for how long or how often? by whom? 8. Have you ever been hurt sexually by another person? Y N Sexual Abuse: includes being forced, threatened or deceived into sexual activities; someone looking or touching you in ways that make you uncomfortable (during bathing, dressing etc.); rape or other unwanted sexual contact; making fun of your body or you in sexual terms; making comments to you that have sexual overtones, etc.; any intentional actions done by another person that are sexual in nature which you do not want. 9. If yes, at what age(s)? , for how long or how often? by whom? . 10. If any of the abuses occurred before your disability, please check the following: Physical: Emotional: Sexual: 11. If any of the abuses resulted in your disability, please check the following: Physical: Emotional: Sexual: 12. Prefer not to answer questions: ___________ (check) REMEMBER: You do not deserve to be hurt in any way, not physically, not emotionally and not sexually! If you are currently being hurt by another person or if you have been hurt in the past by another person but never told anyone, IndependenceFirst can help you, if you want or you can call any of the agencies listed on the attached sheet. Thank you for you participation in this screen. Number:________ (Office use only) Handout #8: The following materials provided by Peg Calvey at LEAP/CIL Sample Training Outline For Community Education On Persons With Disabilities And Abuse I. Introductions a. Presenters and participants b. Goals c. Objectives d. Expected Outcomes II The ADA a. National and local statistics, persons with disabilities b. Definition of disabilities and examples c. Titles II and III (as applicable to audience) III Scope Of The Problem: Persons With Disabilities And Abuse a. Statistics on prevalence of abuse b. Types of abuse (definitions, examples and indicators) c. Perpetrators d. Barriers IV What Can You Do? a. Activity: case scenarios b. Group discussion (Q and A) V Closure a. Closing remarks b. Training evaluation Learning Objective 4: Gain knowledge of three centers for independent living that are addressing abuse issues, how they started and what they do. Handout #9: The following materials provided by Leslie Myers at IndependenceFirst Independent Living Independent living for women with disabilities may raise special problems in the training and supervision of personal care attendants and assistants. Those centers for independent living that offer personal care attendants and assistants services will need to pay attention to reports of abuse and domestic violence, perhaps modifying recruitment, training and supervision of attendants. Centers for independent living may also need to assist women with disabilities with assertiveness training and self defense classes, as well as advocating for changes in domestic violence and sexual assault centers to become accessible and to reach out to women with disabilities (Asch and Fine, 1988). Consumer Education Materials Theories About Domestic Violence 1. Battering Is Caused By A Dysfunctional Relationship: This theory is based on the Family Systems Approach. It assumes a concept of interactive squabbling with a solution of couples counseling. The focus is on teaching the individuals better communication skills. A criticism of this theory is that the battered women's experiences do not fit, they are often battered when they have said or done nothing and even when they are sleeping. Couples counseling can actually be dangerous because things said during counseling may be used to justify continued battering. 2. Cycle Of Violence Theory: Based on the work of Lenore Walker, this theory suggests that there is a cycle to the battering: a tension building stage, an explosion and a honeymoon or stage of calm respite. This theory does not blame the victim and sees the problem not with the couple but instead with the abusive partner's emotional response to stress and anger. Followers of this theory believe in anger management as a solution. A criticism of this theory is that it does not explain why the batterer picks only the woman as the target and not anyone else in his life when he is angry or stressed. The cycle of violence does not match the battered woman's experience. Many do not go through the honeymoon or stage of calm respite. The experience of battering is usually constant. 3. Theory of Power and Control: This theory, developed by Ellen Pence, sees the hierarchical social structure as the foundation in which the battering takes place. A hierarchical structure assumes that the person on top has control over the person on the bottom. In the hierarchical structure, a system of tactics is used to maintain authority, power and control over those on the bottom. This theory most completely describes the battered woman's experience. The batterer uses physical, sexual and coercive tactics within the relationship to control the woman (KASA and Domestic Violence Project). Rape Culture Men and women are conditioned from an early age to accept different roles. Women are raised to be passive and men are raised to be aggressive. We are further conditioned to accept certain attitudes, values and behaviors. Our conditioning is reinforced by the media, cultural attitudes and by the educational system. The media is a major contributor to gender-based attitudes and values. The media provides women with a complete set of behaviors that precipitate rape. Social training about what is proper and lady-like and what is powerful and macho teaches women to be victims and men to be aggressors. The high incidence of rape in this country is a result of the power imbalance between men and women. Women are expected to assume a subordinate relationship to men. Rape is a logical extension of the typical interactions between men and women. The following are some common social rules that women are taught which precipitates this imbalance: When spoken to, a woman must acknowledge the other person with a gracious smile. Smiling and acknowledging almost any approach has become reflexive. For a potential rapist, this can serve as a "pretest" to determine how compliant a woman will be. Because women do not usually consider ignoring an unwanted approach an option, they are more vulnerable. Women must answer questions asked of them. In our culture, the rudest thing a person can do is not answer a direct question. In social situations preceding rape, the man often puts the burden of rejection on the woman by asking things like: "What is wrong with you, don't you like me?" A woman compensates for hurting the man's feelings by complying with his demands. Women must not bother other people or make a scene because they are uncomfortable. It is not lady-like to bother anyone at any time. Women are not expected to intrude but rather be ready to help others at all times. When in trouble, it is best to defer to the protection and judgment of men. The two flaws to this rule are 1) It is men that endanger or bother women and 2) There are not always trustworthy men around to protect women. Casual touching or suggestive comments in social settings are meant as a tribute to a woman's desirability. Many women believe that being ogled by a group of construction workers is merely a form of praise. Many sexual assaults begin with a "harmless" compliment or inquiry from the rapist. The comments are a way of testing how accommodating a woman might be. It is the natural state of affairs for men to carry the financial burden of social situations. This is a popular rationale for men to justify demanding sex. The autonomy and self respect that come with not always allowing an escort to pay is important in reacting to potentially dangerous situations. When engaged in a social encounter, it is not proper for a woman to be superior in any game, sport or discussion if she wants to be accepted. If a woman is never allowed to win at anything with a man, it is expecting a lot to ask a woman to effectively cope with a man who is trying to rape her. Women should always accept and trust the kindness of strangers if they offer help. Women tend to trust people who approach them and offer help. The problem is knowing whether the offer of assistance is genuine or not. Women's vulnerability to rape is a result of their relatively subordinate relationship to men. The set of beliefs and attitudes that divide people into classes by sex and justify one sex's superiority is called sexism. The following dictates serve to maintain this subordinate relationship:  Women's status in society: women occupy a relatively powerless position in society and are the recipients of fewer advantages and privileges. Men's benefits are built into the patriarchal system.  Rape as a mean of control over women: rape plays a role in maintaining patriarchy by perpetrating the threat of violence. The acts of a few men can terrorize and control women's lives; the indifference of other men reinforces this effect.  Women's dependence on men: many women receive most of their benefits through men rather than through their own ability. This dependence is reinforced by the cultural belief that dependence is a "womanly" trait (U.C. Davis). Just as women, men and children have roles that they are expected to play and unwritten rules that they must follow, individuals with disabilities also have their own set of standards. These standards create an atmosphere similar to that of women, which ultimately makes them vulnerable to sexual assault. Some examples of unwritten social rules include: Compliance: Individuals with disabilities are often expected to comply with their caretakers, guardians, the professionals who handle their benefits, and the medical and rehabilitation professionals they are in contact with. Helplessness: The expectation and perception that individuals with disabilities need others in order to function in society creates situations where strangers feel that they have the right to infringe on the individual's personal space and cross over boundaries. Worthlessness: The person has possibly heard over and over from their parents, relatives, friends and professionals what they cannot do. This type of thinking can become internalized, leaving the person thinking that they never will be able to have control over their lives. Nameless/Non-person: Often when a person has a disability they "become" that diagnosis and lose their individuality. Instead of being "Mary" they are "the paraplegic in bed 2A" or the "blind lady who lives in the red house." Compliance puts the individual at risk because by being compliant they are unable to be assertive with the abuser. Helplessness also puts the individual at risk because if that helplessness is internalized, then the person believes they are unable to stand-up or fight against the abuser. A feeling of worthlessness makes the person accept the abuse and therefore believe that the abuse is okay. Lastly, being nameless or a non-person makes the individual believe that they do not deserve to be treated with respect and that the sexual abuse is not a crime because they are not a real person. These obstacles and others can be overcome by the individual learning assertive behaviors, the concepts of boundaries and personal space, and a positive self-image. Sources University of California-Davis, Defining a Rape Culture, Available: Http://pubweb.ucdavis.edu/Documents/RPEP/Rculture.htm Kenoshans Against Sexual Assault (KASA) and Domestic Violence Project, Training Manual, Kenosha, WI. Material from the Kenoshans Against Sexual Assault (KASA) and the Domestic Violence Project training manual were used with permission. Handout # 10: The following information provided by Peg Calvey at LEAP/CIL. SWEAP (SERVICES for WOMEN with disabilities EDUCATION and ASSISTANCE PROGRAM) Project Overview A program of LEAP/CIL in partnership with Genesis House Women's Shelter whose mission is to create awareness of and provide education to service providers and residents of Lorain and Erie Counties, Ohio, about the issue of abuse in the lives of women with disabilities. Project impetus was drawn from the common experiences of abuse among women with disabilities who participated in a series of women support groups sponsored by LEAP/CIL (1996-97). Local demographics: Lorain Co. Erie Co. Population 281,000 76,000 Planned as a three-year project at the completion of which it will lose its "project" status and become a core service provided by LEAP/CIL; first year completed, second just begun. Yearly goals:  Year One (98-99) develop and implement a curriculum for training service providers; train local service providers.  Year Two (99-00) develop and implement protocols for providing intensive case management with the goal being obtaining a safe, independent life for women with disabilities who have experienced or are experiencing abuse in their lives; continue to train service providers.  Year Three (00-01) develop and implement a strategy to export the program beyond Lorain and Erie Counties. Staffed by a full time project coordinator and part time administrative assistant (LEAP/CIL); Genesis House provides personnel resources equivalent to a half time employee. In project year one:  held two three-hour seminars in which 98 service providers were trained  trained 250 Lorain county peace officers and other justice system personnel  held nine onsite training sessions with various service provider agencies, training 60 persons Financial support provided by three local grantmakers:  Nord Family Foundation, Elyria, OH  Nordson Corporation Foundation, Westlake, OH  Stocker Family Foundation, Lorain, OH LEAP/CIL'S: WOMEN'S PROGRAM: A program that addresses the issues that affect the lives of women with disabilities. This program is self directed, self-motivated, and self-determined. CHOICES: You need to find them and EMPOWER yourself with INFORMED CHOICES. This is an 8 to 10-week program in which a series of issues are presented to and discussed by the group. The women meet weekly in a small group setting with no more then seven participants. An atmosphere of trust and caring is encouraged. Subject matter experts are invited to present. Issues discussed include abuse/violence/neglect awareness, gaining control over your life, assertiveness, self-image, family relationships, parenting, access to health care, sexuality, relaxation techniques, handling grief, alcohol and drug abuse, the ADA, and safety in and out of the home. This is a great opportunity to meet other women with disabilities who live in the local community. If these issues affect any part of your life and you want solutions or if you have other needs not listed, telephone LEAP/CIL at 440.323.3444 and ask for Peg or Elsie. Handout #11: The following materials provided by Hillary Colby at Access Living Access Living's Domestic Violence Program Structure Financing the Program: Our program receives funding from several sources: 1. Illinois Attorney General 60% 2. Chicago Foundation for Women 10% 3. Small private grants 30% At Access Living we are fortunate to have a development department that can pursue RFP's (Requests for Proposals). This department files up to 30 grant requests for the domestic violence program per year and has an average return of 10. Below is a basic list of grant makers that fund domestic violence programs. We recommend you contact your local and statewide government and nonprofit organizations about resources in your area. When searching for grants, apply for grants that are general domestic violence and not just focused on disabilities. Many foundations are looking to fund programs that foster collaboration between agencies; consider filing a proposal with another domestic violence program. Potential Funding Resources: Family violence shelters and services, Alton Women's Home Association; The Aurora Foundation; Grace A. Bersted Foundation; The Birkelund Foundation; Blowitz-Ridgeway Foundation; Helen V. Brach Foundation; The Brunswick Foundation, Inc.; The Bufka Foundation; Charleston Area Charitable Foundation; Chicago Community Trust; Chicago Foundation for Women; Chicago Resource Center Chicago Sun-Times Charity Trust; Children's Care Foundation; Citibank Foundation & Corporate Contributions; CLARCOR Foundation; Cole Taylor Bank; Community Memorial Foundation; The DuPage Community Foundation; Fel- Pro/Mecklenburger Foundation; Field Foundation of Illinois, Inc.; Lloyd A. Fry Foundation; GATX Corporation; Harris Foundation; Hartmarx Charitable Foundation; Heyman Family Foundation; Household International; IBM Corporation; The Jessica Fund; John Deere Foundation; Kaplan Foundation; Mayer and Morris Kaplan Family Foundation; Louis R. Lurie Foundation; Mallinckrodt Veterinary, Inc.; Meyer Family Foundation; Montgomery Ward Foundation; The Elizabeth Morse Charitable Trust; The Nalco Foundation; Northern Trust Company Charitable Trust; The John Nuveen Company; Owens Foundation; Peoples Energy Corporation; Peoria Area Community Foundation; Polk Bros. Foundation; Prince Charitable Trusts; Relations Foundation; Benjamin J. Rosenthal Foundation; Sara Lee Foundation; Arthur J. Schmitt Foundation; Dr. Scholl Foundation; Sears, Roebuck and Co.; The Sears-Roebuck Foundation; The Siragusa Foundation; William Wood Skinner Foundation; Steans Family Foundation; 3601 Communications Company; United Way/Crusade of Mercy, Inc.; Urban Options; Herbert C. Wenske Foundation. Domestic Violence Staff Job Descriptions: Attached you will find the official job descriptions listed by our agency. These descriptions serve as guideposts and do not encompass the diversity of work the staff pursues. Each staff member may pursue particular areas of interest as long as they fulfill the basic needs of the clients. For instance, this year the outreach staff member has chosen to focus on the health care system's response to persons with disabilities in domestic violence situations. At Access Living, a domestic violence staff member's day varies by what is happening in the community and by client needs. When a new client contacts Access Living, we perform a general intake assessment as well as address issues specifically related to their domestic violence issues. We determine their level of safety if they stay where they are and create a safety plan to use if that safety is jeopardized. Staff may then meet the client at a court facility to obtain orders of protection or to initiate counseling and other services. Clients are offered the opportunity to participate in support groups and individual counseling with our staff or other domestic violence service providers. Our peer counselor completes most of these client-based activities. The outreach person attends domestic violence community meetings, provides training to service providers and the community, works with different systems such as the legal and housing systems to advocate for full accessibility, and serves as a backup for the peer counselor. The History of our Domestic Violence Program: In 1986, Access Living brought in a staff member from the Legal Assistance Foundation. This person worked in domestic violence and felt that there were little or no services for people with disabilities who were coping with domestic violence. Over the next few years, Access Living began exploring these issues through town hall meetings and informal discussions. In 1990, Access Living officially opened a domestic violence program to respond to the high rate of abuse in the disability community. Over the next several years, Access Living began to participate in the domestic violence community by joining the battered women's network and responding to individual requests for assistance by clients and community agencies. Access Living had to file a complaint to press domestic violence providers into making their programs fully accessible. This led to all shelters in Chicago purchasing and providing training to staff on the use of TTY's. Another major issue tackled was lack of access for the deaf community to the court system. The wait for a sign language interpreter was two weeks. This was unacceptable as domestic violence victims need emergency orders of protection. The Cook County Courts now have two full time sign language interpreters on staff. The advocacy work continues in other areas, such as asking shelters to make their facilities fully wheelchair accessible and pushing for the acceptance of clients with mental health issues. POSITION DESCRIPTION Position Title: Domestic Violence: ILS/Peer CounselorDate: December 1, 1998 Department: Program - Consumer Services Information CoordinationAsst: Rene D. Luna BASIC FUNCTION: Summarize position's purpose This position is responsible for the implementation and development of Access Living's domestic violence program. This includes outreach, intake assessment, domestic violence counseling, shelter/housing resource and referral, client file maintenance, advocacy and follow up. SPECIFIC DUTIES: Describe responsibilities and tasks  develop and implement outreach efforts;  provide intake assessment in a timely manner;  participate in appropriate staffing of clients;  maintain confidentially through appropriate client file maintenance;  conduct peer counseling support groups;  client advocacy;  provide individual peer counseling as needed;  develop and coordinate training efforts for the community regarding disability/ IL related issues;  participate in advocacy efforts and technical assistance in the area of domestic violence;  collect client statistics and do program evaluations;  other duties as assigned. EDUCATION AND TRAINING: Minimum educational background required  BA preferred. EXPERIENCE: Length of time required to develop skills for acceptable performance  Extensive experience with disability. Preferred--understanding of independent living philosophy and experience with domestic violence. PHYSICAL DEMANDS: Nature and extent of standing, stooping, lifting and walking  Ability to travel throughout Chicago. EQUIPMENT OPERATED: Specific equipment, machines, devices and work aids  TTY - Telephone. WORKING ENVIRONMENT: Identify work area and any of its unpleasant elements  None. PROFESSIONAL AFFILIATIONS: Associations to which incumbent may belong  None. NO. OF EMPLOYEES DIRECTLY SUPERVISED:  None. SUPERVISED BY:  CSIC Team Leader POSITION DESCRIPTION Position Title: Domestic Violence: ILS/OutreachDate: July 1, 1998 Department: Program - Consumer Services Information Coordination Asst: Rene D. Luna BASIC FUNCTION: Summarize position's purpose This position is responsible for the implementation and development of Access Living's outreach activities to community organizations that increase Access Living's visibility, promote Access Living programs, and promote disability awareness, Access Living's domestic violence agenda, the network of disability rights advocates, and coalition building. SPECIFIC DUTIES: Describe responsibilities and tasks  to increase architectural and communication accessibility in Chicago;  increase disability awareness;  organize agencies and organizations around issues of independence;  provide workshops and seminars designed to move other agencies and organizations to systems advocacy for people with disabilities;  provide expertise on systems advocacy for allied agencies and organizations;  provide information on specific issues effecting the disability community. EDUCATION AND TRAINING: Minimum educational background required  BA preferred. EXPERIENCE: Length of time required to develop skills for acceptable performance  Demonstrates competency in written and oral communications. 2-3 years experience in field of independent living or other disability-related advocacy required. Experience in community organizations, working knowledge of organizing and coordinating volunteers. PHYSICAL DEMANDS: Nature and extend of standing, stooping, lifting and walking  Ability to travel. EQUIPMENT OPERATED: Specific equipment, machines, devices and work aids  None. WORKING ENVIRONMENT: Identify work area and any of its unpleasant elements  None. PROFESSIONAL AFFILIATIONS: Associations to which incumbent may belong  None. NO. OF EMPLOYEES DIRECTLY SUPERVISED:  None. SUPERVISED BY:  CSIC Team Leader Learning Objective 5: Discuss the issues of accessing services and the sensitive nature of these activities. Handout #12: The following materials provided by Leslie Myers at IndependenceFirst Reasons for Not Disclosing and Policy and Procedure Women with disabilities face a number of barriers when they try to tell someone about the violence. Some examples of these barriers are: FEAR: Offenders who have an economic hold or social power over the woman they abuse may keep her from disclosing the violence. They may threaten to withdraw their services, hurt the woman's family member or take away her children. ISOLATION: Some women have had little or no contact with anyone other than their caregivers, particularly when they live in institutions. When a caregiver becomes the offender, the woman is left with few or no options. LACK OF ACCESS: Women with disabilities do not have full access to violence related support services. When they do not know that the services exist or cannot gain access to them, they have little opportunity to tell someone about the violence in their lives. CREDIBILITY: Women with disabilities are considered less competent and less reliable as witnesses than other women simply because they have a disability (Cusitar, 1994). The following pages are IndependenceFirst's Policy and Procedures For Addressing Abuse Issues with Consumers, which may be duplicated and/or altered to fit your agency's needs as long as proper credit is given to IndependenceFirst. IndependenceFirst Policy and Procedures For Addressing Abuse Issues with Consumers Mandatory Reporting: When victim is under 18 years old: child abuse (i.e. physical, emotional and verbal), neglect and sexual assault must be reported to Child Protective Services (Milwaukee: 289-6444) or the local police [Wis. Statute 48.981(2)]. For more information see crimes against children [Wis. Statute 948.01]. Note: There is no statute of limitation on child abuse, any disclosure of abuse by someone under 18 years old must be reported no matter when the abuse happened.  Suspected abuse of children under age 18 must be reported to Child Protective Services (Milwaukee: 289-6444) or the local police. Abuse of vulnerable adults: [see criminal code Wis. Statute 940.285 attached]. [Wis. Statute 55.001 to 55.07] covers the Wisconsin Protective Service System which defines "Abuse" as any of the following: A) An act, omission or course of conduct by another that is inflicted intentionally or recklessly and that does at least one of the following: 1- results in bodily harm or great bodily harm (means bodily injury which creates a substantial risk of death or which causes serious, permanent disfigurement or which causes permanent or protracted loss or impairment of the function of any bodily member or organ or other serious bodily injury) to a vulnerable adult or 2- intimidates, humiliates, threatens, frightens or otherwise harasses a vulnerable adult. B) The forcible administration of medication to a vulnerable adult, with the knowledge that no lawful authority exists for the forcible administration. C) An act that constitutes first degree, second degree, third degree or fourth degree sexual assault. [see Wis. Statute 940.225 criminal code]. "Neglect" is defined as an act, omission or course of conduct that because of the failure to provide adequate food, shelter, clothing medical care or dental care, creates a significant danger to the physical or mental health of a vulnerable adult. The department or agency providing protective services may provide such services under any of the following conditions: A) The person who needs or believes he/she needs protective services may seek such service. B) Any interested person (any adult relative or friend of a person to be protected under this subchapter or any official or representative of a public or private agency, corporation or association concerned with the person's welfare) may request protective services on behalf of a person in need of services. A guardian may request and consent to protective services on behalf of the guardian's ward. C) The department may provide services on behalf of any person in need of such services. D) Court order.  Suspected abuse of vulnerable adults age 18 to 59 can be reported to Adult Services (Milwaukee: 289-6660). Elder Abuse: [Wis. Statute 46.90]-Elder Abuse Reporting System "Elder person" means a person who is age 60 or older or who is subject to the infirmities of aging. "Abuse" means the willful infliction on an elder person of physical pain or injury or unreasonable confinement. "Material Abuse" means the misuse of an elder person's property or financial resources. "Neglect" means a significant danger to an elder person's physical or mental health because the person who takes care of the elder person is unable or fails to provide adequate food, shelter, clothing or medical or dental care. "Self-Neglect" means a significant danger to an elder person's physical or mental health because the elder person is responsible for his or her own care but is unable to provide adequate food, shelter, clothing or medical or dental care. Any person may report to the county agency or to any state official, including any representative of the office of the long term care ombudsman, that he or she believes that abuse, material abuse or neglect has occurred if the person is aware of facts or circumstances that would lead a reasonable person to believe or suspect that abuse, material abuse or neglect has occurred. The person shall indicate that facts and circumstances of the situation as part of the report. Any person who believes that self-neglect has occurred may report that belief and the facts and circumstances contributing to the belief to the county agency or to any state official, including any representative of the office of the long term care ombudsman.  Suspected abuse of adults age 60 and older can be reported to Elder Abuse Hotline (Milwaukee: 276-4488) ABUSE OF VULNERABLE ADULTS Wis. Stats. Sec. 940.285 1. Definitions. In this section: (a) "Developmentally disabled" person has the meaning specified on Sec. 55.01 (2). (b) "Infirmities of aging" has the meaning specified in Sec. 55.01 (3). (bm) "Maltreatment" includes any of the following conduct: 1. Conduct that causes or could reasonably be expected to cause bodily harm or great bodily harm. 2. Restraint, isolation or confinement that causes or could reasonably be expected to cause bodily harm or mental or emotional damage, including harm to the vulnerable adult's psychological or intellectual functioning that is exhibited by severe anxiety, depression, withdrawal, regression or outward aggressive behavior or a combination of these behaviors. This subdivision does not apply to restraint, isolation or confinement by a court or other lawful authority. 3. Deprivation of a basic need for food, shelter, clothing or personal or health care, including deprivation resulting from the failure to provide or arrange for a basic need by a person who has assumed responsibility for meeting the need voluntary or by contract, agreement or court order. (c) "Mental illness has the meaning specified in Sec. 55.01 (5). (d) "Other like incapacitates" has the meaning specified in Sec 55.01 (5). (dm) "Recklessly" means any conduct that creates a situation of unreasonable risk of harm and demonstrates a conscious disregard for the safety of the vulnerable adult. (e) "Vulnerable adult" means any person 18 years of age or older who either is a developmentally disabled person or has infirmities of aging, mental illness or other like incapacitates and who is: 1. Substantially mentally incapable of providing for his or her needs for food, shelter, clothing or personal or health care; or 2. Unable to report cruel maltreatment without assistance. DEFINITIONS of ABUSE: SEXUAL ABUSE: being forced, threatened or deceived into sexual activities. Sexual Abuse: includes being forced, threatened or deceived into sexual activities; someone looking or touching you in ways that make you uncomfortable (during bathing, dressing etc.); rape or other unwanted sexual contact; making fun of your body or you in sexual terms; making comments to you that have sexual overtones, etc.; any intentional actions done by another person that are sexual in nature which you do not want. The American Medical Association defines sexual abuse as any form of forced sex or sexual degradation that includes trying to make a woman perform sexual acts against her will, pursuing sexual activity when she is not fully conscious or is not asked or is afraid to say no, hurting her physically during sex or assaulting her genitals, coercing her to have sex without protection against pregnancy or STDs and criticizing her and calling her sexually degrading names. The abuse can be intra-familial or extra-familial, homosexual or heterosexual, single incident, repeated or chronic, planned or spontaneous and may include violence or sadism. Sexual abuse may or may not be accompanied by physical abuse. PHYSICAL ABUSE: includes any intentional violence against your body including: being hit, kicked, restrained, pushed, etc.; the withholding of care including: denied food, water, mobility aids, medications, personal care (bathing, changing your clothes, allowing you to lay in your own body waste, etc.), etc.; intentional rough/hurtful handling including: dropping you during transfer, causing pain in your arms, legs, head and/or torso during bathing, dressing or transferring, etc.; any intentional actions done by another person that causes you physical pain. Also using physical force in the form of slapping, punching, hitting with objects, kicking, scalding or slamming into walls to ensure sexual compliance, to prevent disclosure or to achieve sexual satisfaction with bruising, lacerations, fractures, scars, sensory damage or brain damage occurring as a result. Extreme violence, i.e. stabbing, ritual torture and mutilation may result in death. EMOTIONAL ABUSE: includes being threatened, verbally attacked or terrorized; rejecting, ignoring, corrupting, teasing you (making fun of you, calling you names, talking about you to another person like you were not present), etc.; stealing money or other items from you; isolating you from friends or family, etc.; any intentional actions done by another person that causes you emotional pain. Emotional abuse is always a component of the other types of abuses. Two aspects of emotional abuse: The effects of physical or sexual abuse on the women's emotional state and the emotional changes that result from verbal assaults or emotional deprivation. POSSIBLE SIGNS of ABUSE  Flashbacks  Boundary extremes (person establishes relationships which are either extremely detached both emotionally and physically or extremely enmeshed in the other person)  Addictions  Depression  Flat affect  Sexually Transmitted Diseases (STD)  Change in sleeping patterns  Dissociation/Zoning out  Help-rejecting behavior/Labeled as a "problem"  Suicidal thoughts and attempts  Chronic pains with undiagnosed causes.  Mental illness diagnosis  Loss of appetite/overeating  Self-mutilation  Abrupt personality changes  Uncontrollable crying  Fear of leaving home  Nightmares and terrors POSSIBLE SIGNS of CHILD ABUSE The following is a brief lists of the signs seen in child abuse, it is not meant to be all inclusive: Signs of physical abuse: bruises, injuries in the shape of objects, fearful of adults including parents, afraid to go home, fractures or unexplained burns. Signs of emotional abuse: low self esteem, withdrawn, anxiety, failure to learn, aggression and depression. Signs of neglect: poor hygiene, odor, inappropriate dress for weather, failure to thrive, poor nutrition, extreme willingness to please and constant hunger. Signs of sexual abuse: sexualized relationships, stained or bloody underclothing, pain, swelling or itching in genital area, poor peer relationships and difficulty walking or sitting. HINTS for SCREENING  ALWAYS talk with the person alone and in private areas.  Convey an attitude of respect and concern.  Indirect Prompts: Ask about "Symptoms" (how do you sleep, do you experience loss of time/memory problems, have you attempted or thought about suicide etc.)  Direct Prompts: "Many of the people I have met with have been hurt in a sexual way. Has anyone ever forced you to do something sexually that you didn't want to do?, Recently?, In your childhood?"  Present threat: "Do you feel safe at home?" Remember, when a consumer fills out the screen, this may be the first time the individual has ever discussed the abuse and you need to be prepared to let them talk about the abuse if they want to and assess the individual's general well-being and state of mind. RESPONDING to "DISCLOSURES" of ABUSE  Express concern and remain calm.  Validate expressed feelings (let person know that it is O.K. to feel the way they do and that you believe what they are saying).  Acknowledge injustice.  Invite the person to talk about the assault or abuse if they would like to.  Tell the person you know of help and make a referral. Assessing for safety:  Have you ever been hurt or threatened?  Have you been hurt or threatened by someone since the last time we saw you?  Has anyone at home hit you or tried to hurt you in other ways?  Has anyone else hit you or tried to hurt you?  Has anyone forced you into sexual activities?  Are you afraid of someone close or important to you?  Are you afraid of someone else? If the answer to any question is YES and the situation is urgent or a crisis: Let the consumer know that no one deserves to be hurt or threatened. Assess consumers ability to keep self safe or the need for a shelter. Offer referral to in-house staff to assist in assessing services. If the answer to any question is YES but the situation is non-urgent: Let the consumer know that no one deserves to be hurt or threatened. Encourage consumer to talk about it. Listen non-judgmentally. Validate. Offer written information on resources available. If the answers are NO but there are signs of abuse/neglect: Ask more specific questions, assess safety/danger. Follow guidelines for urgent/non-urgent situations as appropriate. If the answers are NO and there are no indicators of abuse/neglect: Let consumer know resources and information are available if needed. Remember: DO NOT force the consumer into making a report of the abuse, let consumer control what, how and when they discuss the abuse. Offer resources, information and support. INDEPENDENCEFIRST PERSONNEL  Know your employer's policy and procedure.  Explain confidentiality.  Ask consumer if they need medical treatment.  Document the disclosure.  File any necessary reports.  Ask consumer if they need immediate intervention by IndependenceFirst, police, medical care or another agency.  Make referral.  Use discretion in sharing (release of information). Remember, as an agency it is not our position to investigate the abuse but rather to inform and support the individual should they choose to report the abuse to the local law enforcement agency. Related to this is that if our job is not to investigate, it is also not our place to question or disqualify anyone's disclosure of abuse and instead we should respect and validate the individual's feelings and concerns. Modified from "Assessing Patients for Family Violence: A Guide for Health Care Providers" by Siani Samaritan Medical Center. Handout # 13: The following material, which is information taken from the protocol, was contributed by Debora Beck-Massey from Domestic Violence Initiative, Denver, Colorado. The Colorado Revised Statue 12-36-135 (a) says: "Domestic Violence" means an act of violence upon a person with whom the actor is or has been involved in an intimate relationship. Domestic Violence also includes any other crime against a person or any municipal ordinance violation against a person when used as a method of coercion, control, punishment, intimidation or revenge directed against a person with whom the actor is or has been involved in an intimate relationship. Are you Abused? Physical Abuse Has your partner:  pushed or shoved you  held you to keep you from leaving  slapped or bit you  kicked or choked you  hit or punched you  thrown objects at you  locked you out of the house  abandoned you in dangerous places  refused you help when you were sick, injured or pregnant  subjected you to reckless driving  forced you off the road or kept you from driving  raped you  threatened to hurt you with a weapon  denied you medical treatment, medication, food , water  kept you locked into a room  disabled your wheelchair, medical equipment, hid you cane or walker  denied you your money, Medicaid card, put himself as payee on your disability money Sexual Abuse  told anti-woman jokes or made demeaning remarks about women  treated women as sex objects  been jealously angry, assuming you would have sex with any available man  insisted you dress in a more sexual way than you wanted  minimized the importance of your feelings about sex  criticized you sexually  insisted on unwanted and uncomfortable touching  withheld sex and affection  called you sexual names like "whore" or "frigid"  forced you to strip when you didn't want you to  publicly showed sexual interest in other women  had affairs with other women after agreeing to a monogamous relationship  forced sex with him or others or forced you to watch others  forced particular unwanted sexual acts  forced sex after beatings  forced sex when you were sick or it was a danger to your health  forced sex for the purpose of hurting you with objects or weapons  committed sadistic sexual acts Emotional Abuse  ignored your feelings  ridiculed or insulted women as a group  ridiculed or insulted your most valued beliefs, your religion, race, heritage, or class  told you no one would want a "cripple"  withheld approval, appreciation or affection as punishment  continually criticized you, called you names, shouted at you  insulted or drove away your friends or family  humiliated you in private or public  refused to socialize with you  kept you from working, controlled your money, made all decisions  refused to work or share money  took car keys or money away  regularly threatened to leave or told you to leave  threatened to hurt you or your family or kids  punished or deprived the children when he was angry at you  threatened to kidnap the children if you left him  abused pets to hurt you  told you about his affairs  harassed you about affairs he imagined you were having  manipulated you with lies and contradictions  made you account for every minute of your time, or money  told you it was your fault he abuses you, because of your disability  made you doubt your sanity  made you think you had done something when you had not SECTION IV ADDITIONAL RESOURCES Abuse of Children and Adults with Disabilities by Nora Baladerian, 1993. Disability, Abuse and Personal Rights Project, PO Box T, Culver City, CA 90230-0090; 310-391-2420 Ext. 333. $10 A prevention and intervention guidebook for parents and other advocates, addressing vulnerability, identification, and reporting abuse. Abuse of Children and Adults with Disabilities: Guidebook for Parents by Nora Baladerian, 1993. Disability, Abuse & Personal Rights Project, P. O. Box T, Culver City, CA 90231; 213-391-2420. $10 A guidebook for parents and advocates on why abuse occurs, how to identify abuse, reporting, and providing mental health treatment. Abuse: The Loss of Abundance, the Art of Healing by Luciano Matheron, 1994. Brazen Video 2314 East Dayton, Madison, WI 53706; (608) 249-8428. $25 This creative, artistic video discusses abuse of children and the ongoing trauma faced by survivors. Answering the Call: Police Response to Violence Against People with Disabilities by Cameron Crawford, 1993. Roeher Institute, York University, 4700 Keele St., No. York, Ontario M3J1P3; (416) 661-9611. $22 A study of awareness of violence against people with disabilities among police; discussion of reporting and other police processes. At Greater Risk: Legal Issues in Sexual Abuse of Adults with Developmental Disabilities by Joyce Feustel, 1991. Wisconsin Council on Develop. Disabilities, 722 Williamson St., 2nd Floor, PO Box 7851, Madison, WI 53707-7851; (608) 266-7826. $2 Training guide for caregivers; deals with sexual abuse of people with developmental disabilities, risk factors, legal issues and protective services. Doubly Silenced: Sexuality, Sexual Abuse and People with Developmental Disabilities by Patricia Miles Patterson, MSSW, 1991. Wisconsin Council on Devel. Disabilities, 722 Williamson St, 2nd Fl, POB 7851, Madison, WI 53707-7851; (608) 266-7826. $3 A book about sexuality, sexual assault and abuse, and people with developmental disabilities; includes barriers to sexual expression. Harm's Way: The Many Faces of Violence and Abuse Against Persons with Disabilities by Marcia Rioux, 1995. Roeher Institute, York University, 4700 Keele St., North York, Ontario M3J1P3; (416) 661-9611. $28 Examines forms of violence and abuse towards people with disabilities, how people with disabilities define abuse, and factors creating vulnerability. LifeFacts: Sexual Abuse Prevention by Nancy Cowardin, 1990. James Stanfield Co. P.O. Box 41058, Santa Barbara, CA 93140; 1-800-421-6534. $199 Utilizes bold line drawings to illustrate recognizing sexual abuse, self-protection strategies, reporting and coping with sexual assault. Managing Inappropriate Sexual Behavior by Karen Ward, 1992. Alaska Specialized Education/Training Services. VIDA Publisher, P.O.B. 331, Willow Street, PA 17584; (717) 786-8000. $23 A practical guide to working with adults with disabilities who are offenders or display inappropriate sexual behaviors. No More Victims: A Guide to Police in Addressing Sexual Abuse of People with Mental Handicap by Roeher Institute, 1992. Roeher Institute, York University, 4700 Keele St., North York, Ontario M3J1P3; (416) 661-9611. $18 A manual for police in addressing sexual abuse of people with cognitive disabilities (on computer diskette). No More Victims: A Manual to Guide Families and Friends by Roeher Institute, 1992. Roeher Institute, York University, 4700 Keele St., North York, Ontario M3J1P3; (416) 661-9611. $18 A manual for families and friends in addressing sexual abuse of people with cognitive disabilities. No More Victims: A Manual to Guide Social Workers and Counselors by Roeher Institute, 1992. Roeher Institute, York University, 4700 Keele St., North York, Ontario M3J1P3; (416) 661-9611. $18 A manual for social workers and counselors in addressing sexual abuse of people with cognitive disabilities. Preventing Sexual Abuse of Persons with Disabilities by Bonnie O'Day, 1983. Minnesota Program for victims of sexual assault, 300 Bigelow Bldg., 450 N. Syndicate St., St. Paul, MN 55104; (612) 642-0256. Safety Skills: Learning How to be Careful by Janie Haugen, 1992. PCI Educational Publishing, 5221 McCullough, San Antonio, TX 78212; (800) 594-4263. $49.95 This board game teaches life skills relating to home, community and health safety issues, using a fun and interactive format for up to six players. Serving Women with Disabilities: A Guide for Domestic Abuse Programs by Leslie Myers, 1999. IndependenceFirst, 600 W. Virginia, Suite 301, Milwaukee, WI 53204; (414) 291-7520. $10.00. Available in alternate formats. Sexual Abuse Prevention for Children with Physical Handicaps by Planned Parenthood Association of Cincinnati, Inc.,1991. Agency for Instructional Technology, Box A, 1111 West 17th St., Bloomington, IN 47402; 800-457-4509. $125 Training video for children with disabilities; shows different situations with potential for abuse, how to stay safe, and how to report. Sexual Abuse Prevention Programs and Mental Handicap by Roeher Institute, 1989. Roeher Institute, York University, 4700 Keele St., North York, Ontario M3J1P3; (416) 661-9611. A special report which includes the results of a committee's evaluation of several commercially available sexual abuse prevention curricula. Sexual Abuse Prevention: Five Safety Rules for Persons Who Are Mentally Handicapped by Planned Parenthood Assn. of Cincinnati, Inc., 1987. Agency for Instructional Technology, Box A, 1111 W. 17th St., Bloomington, IN 47402; 800-457-4509. $150 Training video for persons with developmental disabilities; concrete instruction on concept of sexual abuse, and skills for self protection. Includes instructor's manual. Sexuality and Sexual Assault: Disabled Perspective by Health and Rehabilitation Services Program, Southwest State University, Marshall, MN 56258; (507) 537-6296. Sobsey, Dick; Gray, Sharmaine; Wells, Don; Pyper, Diane; Reimer-Heck, Beth. Disability, Sexuality, And Abuse: An Annotated Bibliography. Baltimore, MD: Paul H. Brookes Publishing Co., 1991. xii, 185p. [Z5346 So12]. STARS 2 for Children by Susan Heighway, 1993. Wisconsin Council on Developmental. Disabilities, 722 Williamson St., 2nd Floor, POB 7851, Madison WI 53707; (608) 266-7826. $10 A guidebook for teaching positive sexuality and the prevention of sexual abuse for children with developmental disabilities. "Study on Disabilities and Sexual Abuse," Journal Of Visual Impairment & Blindness, Vol. 86, No. 4, April 1992. p. 194. [HV1571 VIB] The Criminal Justice System and Mental Retardation by Ronald Conley, 1992. Paul Brookes Publishing Co., P. O. Box 10624, Baltimore, MD 21285-0624; 410-337-9580. $29 This book discusses issues faced by people with intellectual disabilities who enter the criminal justice system as either victims or defendants. "Theme Issue on Disabled Children and Sexual Abuse," Journal Of Visual Impairment & Blindness, Vol. 87, No. 1, January 1993. p. 25. [HV1571 VIB] The Woodrow Project by Lynn Dreyer, 1986. Red Flag Green Flag Resources, Box 2984, Fargo, ND 58108; 800-627-3675. $99.95 Instructor's guide and 25-minute video provide a curriculum for teaching self-protection skills to people with mental retardation. Violence & Disability: An Annotated Bibliography by Dick Sobsey, 1995. Paul Brookes Publishing Co., P. O. Box 10624, Baltimore, MD 21285-0624; 410-337-9580. $28 An alphabetized, cross-referenced listing of literature pertinent to disability, violence, and abuse; for professionals and advocates. Violence and Abuse in the Lives of People with Disabilities by Dick Sobsey, 1994. Paul Brookes Publishing Co., P. O. Box 10624, Baltimore, MD 21285-0624; 410-337-9580. $27 Addresses conditions fostering prevalence of abuse of persons with disabilities and describes prevention strategies. Violence and People with Disabilities: A Review of the Literature by Miriam Ticoll, 1992. Roeher Institute, York University, 4700 Keele St., North York, Ontario M3J1P3; (416) 661-9611. A useful resource analyzing literature on violence towards people with disabilities and society's response. Vulnerable: Sexual Abuse and People with an Intellectual Handicap by Charlene Senn, 1988. Roeher Institute, York University, 4700 Keele St., North York, Ontario M3J1P3; (416) 661-9611. $20 Discusses the prevalence of child sexual abuse, risk factors for kids and adults with disabilities, and effects and treatment of abuse. When the Bough Breaks: A Helping Guide for Parents of Sexually Abused Children by Aphrodite Matsakis, 1991. New Harbinger Publications, Inc., 5674 Shattuck Avenue, Oakland, CA 94609; (800) 748-6273. $11.95 A guidebook for parents which discusses grieving, disclosure, coping with others, tools for healing, and handling feelings. Women with Disabilities: Found Voices by Mary Willmuth , 1993. Haworth Press, Inc., 10 Alice Street, Binghamton, NY 13904-1580; (800) 342-9678. $15 This book features a variety of articles on women with disabilities, including therapy, parenthood, aging, technology, and abuse. Women with Disabilities: Issues, Resources, Connections by Rannveig Traustadottir, 1990. Center on Human Policy, Syracuse Univ., 200 Huntington Hall, 2nd Floor, Syracuse, NY 13244; (315) 443-3851. $10 Discusses obstacles to equality, life histories, personal accounts, sexuality and sexual abuse, teaching others, and building connections. Working with Abuse Survivors: A Guide for Independent Living Centers by Leslie Myers, 1999. IndependenceFirst, 600 W. Virginia, Suite 301, Milwaukee, WI 53204; (414) 291-7520. $15.00. Available in alternate formats. OTHER INFORMATION OF INTEREST National Domestic Violence Hotline: 1-800-799-SAFE (7233) (Voice) or 1-800-787-3224 (TTY). National Sexual Assault Hotline: 1-800-656-HOPE (4073). WEB SITES: Abuse of the Disabled http://www2.addr.com/~sariaa/onroad/abusedis.htm Adults With Vulnerability http://www.library.utoronto.ca/aging/awvhome.htm All Walks of Life http://www.awol-texas.org/ Annotated Bibliographies: Sexuality and Disability http://www.siecus.org/pubs/biblio/bibs0009.html Berkeley Planning Associates: Service Needs of Women with Disabilities: Disabled Women Rate Caregiver Abuse And Domestic Violence Number One Issue http://www.bpacal.com/pressrel.html Center for Research on Women with Disabilities http://www.bcm.tmc.edu/crowd/ Disabled Persons Protection Commission (DPPC): "Abuse Prevention" http://www.state.ma.us/dppc/prevention.html Disabled Persons Protection Commission (DPPC): "Indicators of Abuse" http://www.state.ma.us/dppc/abuseindicator.html DisAbled Women's Network (DAWN) http://www.dawn.tyenet.com/ Domestic Violence & The Disabled http://idt.net/~mauro/adomvio.html The Dynamics Of Sexual Assault And People With Disabilities http://www.danenet.wicip.org/dcccrsa/saissues/disable.html Family Violence Against Women With Disabilities http://hwcweb.hwc.ca/hppb/familyviolence/html/womendiseng.html Family Violence and People with a Mental Handicap http://www.hc-sc.gc.ca/hppb/familyviolence/html/fvmentaleng.html International Coalition on Abuse and Disability (ICAD) http://www.quasar.ualberta.ca/ddc/ICAD/icad.html International Leadership Forum for Women with Disabilities http://www.empowermentzone.com/dsbwomen.txt The Invisible Victims -- A Disturbing Report http://www.psych-health.com/victims.htm People with Mental Retardation & Sexual Abuse http://www.thearc.org/faqs/Sexabuse.html Responding to Victims with Disabilities http://www.ojp.usdoj.gov/ovc/assist/nvaa/supp/t-ch21-12.htm Through the Looking Glass (TLG) http://www.lookingglass.org/index.html OTHER REFERENCE INFORMATION Asch, A, and Fine, M. (1988). Introduction: Beyond pedestals. In M. Fine and A. Asch (1988). Women with disabilities: Essays in psychology, culture and politics (pp. 1-37). Philadelphia, PA: Temple University Press. Cusitar, L. (1994). Strengthening the links: Stopping the violence. Toronto: The DisAbled Women's Network (DAWN). Dell Orto, A.E. and Marinelli, R.P. (Eds.) (1995). Encyclopedia of disability and rehabilitation. New York: Simon and Schuster MacMillian. Fine, M. and Asch, A. (1988). Women with disabilities: essays in psychology, culture and politics. Philadelphia, PA: Temple University Press. Fisher, B. and Galler, R. (1988). Friendship and fairness: How disability affects friendship between women. In M. Fine and A. Asch (1988). Women with disabilities: essays in psychology, culture and politics (pp.172-194). Philadelphia, PA: Temple University Press. Fortine, D. (1987). Living safely for people with special needs: based on the protective behaviors process. PB Eau Claire, WI. Krotoski, D.M., Nosek, M.A. and Turk, M.A. (Eds.) (1996). Women with physical disabilities: achieving and maintaining health and well being. Baltimore: Paul H. Brookes Publishing Co., Inc. Meyer, J. and Meyer, J. (1995). Personal safety tips for people with disabilities. Available online: http://www.usinter.net/wasa/contents4a.html Myers, L.A. (1999). Serving women with disabilities: a guide for domestic abuse programs. Milwaukee, WI: IndependenceFirst. Myers, L.A. (1999).Working with abuse survivors: a guide for independent living centers. Milwaukee, WI: IndependenceFirst. Nosek, M.A. (1996). Sexual abuse of women with physical disabilities. In D. M. Krotoski, M.A. Nosek and M.A. Turk (Eds.), Women with physical disabilities: achieving and maintaining health and well being (pp.153-173). Baltimore: Paul H. Brookes Publishing Co., Inc. Nosek, M.A. and Howland, C. (1997). Sexual abuse and people with disabilities. In M.L. Sipski and C.J. Alexander, Sexual function in people with disability and chronic illness (pp. 577-594). Gaithersburg, Maryland: Aspen Publishers, Inc. O'Day, B. (1983). Preventing sexual abuse of persons with disabilities. Santa Cruz CA: Network Publications. Rousso, H. (1988). Daughters with disabilities: defective women or minority women? In M. Fine and A. Asch, Women with disabilities: essays in psychology, culture and politics (pp.139-171). Philadelphia, PA: Temple University Press. Rubin, S.T. and Roessler, R.T. (1995). Foundations of the vocational rehabilitation process. Austin, TX: PRO-ED, Inc. Schaller, J. and Lagergren Frieberg, J. (1998). Issues of abuse for women with disabilities and implications for rehabilitation counseling. Journal of applied rehabilitation counseling, 29 (2), pp. 9-17. Sipski, M.L. and Alexander, C.J. (1997). Sexual function in people with disability and chronic illness. Gaithersburg, Maryland: Aspen Publishers, Inc. Stuart, V.W. (1980). Sexuality and sexual assault: disabled perspective. Marshall, MN: Health and Rehabilitation Services Program. Weinberg, J.K. (1988). Autonomy as a different voice: women, disabilities and decisions. In M. Fine and A. Asch. Women with disabilities: essays in psychology, culture and politics (pp. 269-296). Philadelphia, PA: Temple University Press. Young, M.E., Nosek, M.A., Howland, C., Changpong, G. and Rintala, D.H. (1997). Prevalence of abuse of women with physical disabilities. Archives of physical medicine and rehabilitation (78), pp. S34-S38. TELECONFERENCE AUDIO TAPE ORDER FORM An audio cassette of the teleconference entitled: Barriers to Independence: Abuse in the Lives of Individuals with Disabilities is available. If you would like a copy, please fill out the order form below. NAME: CENTER: ADDRESS: TELEPHONE: FAX: Number of sets: x $15.00 = $ (shipping included) Please mail order form and payment to: National Council on Independent Living 1916 Wilson Blvd., Suite 209 Arlington, Virginia 22209 703-525-3406 (v) 703-525-4153 (TTY) 703-525-3409 (fax)