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Violence Against Women with Disabilities--Fact Sheet #1: Findings from Studies 1992-2002

Fact Sheet #1

Violence Against Women with
Physical Disabilities

Findings from Studies Conducted by the
Center for Research on Women with Disabilities
At Baylor College of Medicine


1992-2002


Margaret A. Nosek, Ph.D., Principal Investigator
Rosemary B. Hughes, Ph.D., Project Director

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 at the University of Michigan, strongly urged us to include in this study questions about abuse. To our great surprise, a very high rate 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 finding as a mandate from the more than 1,000 women who participated in the study to delve deeper into the causes of and solutions to this problem.

In listening to the stories of the women with disabilities in our study, we began to understand that there are at least three aspects to the problem of abuse. First and foremost, it is a very personal problem of the woman as an individual. Her abilities 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 both 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 response of rehabilitation counselors, independent living centers, and battered women's programs to abuse of women with disabilities. The Centers for Disease Control and Prevention funded our study of strategies to identify and assist abused women with disabilities, and to 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, Ph.D.
March 5, 2002

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The Personal Side of Abuse

Although women with disabilities and women without disabilities experience very high rates of emotional, physical, and sexual abuse, women with disabilities are more likely to experience abuse at the hands of a greater number of perpetrators and for longer periods.

* Women with physical disabilities reported emotional, physical, or sexual abuse in their lifetimes as frequently as women without disabilities (62%). About half of the women in each group (52%) reported experiencing physical or sexual abuse. 13% of women with physical disabilities describe experiencing physical or sexual abuse in the past year.

* Women with physical disabilities and women without disabilities were equally likely to have experienced abuse during childhood.

* The most common perpetrators were 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 intense patterns of abuse over their lifetimes than women without disabilities.

* Physical and sexual abuse are strongly associated with depression and stress in women with physical disabilities.

In addition to the types of abuse experienced by women in general, women with disabilities experience some types of abuse that are specifically related to their disabilities.

* Disability-related emotional abuse takes the forms of emotional abandonment and rejection; threatening, belittling, and blaming; denial of disability; and accusation of faking.

* Disability-related physical abuse takes the forms of physical restraint or confinement; withholding 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 forms of demanding or expecting sexual activity in return for help, and taking advantage of physical weakness and an inaccessible

* Certain disability-related settings, such as hospitals, doctors' offices, and special transportation services, may create a restrictive environment by separating disabled women from their mobility devices, imposing restraint, or forcing isolation 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 related to disability.

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Society's Response to Abuse

Although many battered women's programs report making accessible services available to women with disabilities, few women actually receive these services.

* Our survey of 598 battered women's programs showed a wide variation in the number of women with disabilities 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. In 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% dedicated a staff member to provide services to women with disabilities.

* 49% of the programs reported that the most effective outreach activities for making women with disabilities aware of their services were community presentations and training, but only 16% conducted such activities.

Rehabilitation counselors rarely ask their clients about problems of abuse, although they acknowledge that abuse can interfere with the achievement of rehabilitation goals.

* Our survey of 535 rehabilitation service providers showed that 75% 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 abused women with disabilities. 80% believed it was within their job responsibilities to address their clients' abuse issues.

* In spite of the 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 abused women with disabilities.

* 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 to build 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 attendants to women who are in shelters or who need temporary services 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 ILC staff on abuse issues.

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Recommendations

Battered women's programs should:

* Make shelters for battered women fully accessible, including barrier-free access to sleeping rooms and common areas, architectural features that comply with the Americans with Disabilities Act, visual and auditory alarm systems, and TDDs for telephone communication.

* Make all services offered by battered women's programs (e.g., hotlines, individual counseling, support groups) fully accessible and integrated for women with disabilities.

* Provide, or refer to, legal assistance for obtaining restraining orders and managing court systems.

* Keep statistics on the number of women with disabilities who call crisis hotlines or use other program services.

* Encourage police to record disability status in crime reports and to develop a category for perpetrators who are caregivers.

* Invite independent living centers to train staff on how to communicate with persons who have hearing, cognitive, speech, or psychiatric impairments. When offering advice or referrals for obtaining shelter, staff should understand environmental barriers faced by women with physical and sensory disabilities.

* Have on hand an extensive network of community referrals and contact numbers, including resources for obtaining personal assistance, medication, and assistive devices.

* Offer training to disability-related service providers on how to recognize the symptoms of abuse and the characteristics of potential batterers, and on how to refer abused women with disabilities to resources for battered women in their community.

Independent living programs should:

* Become familiar with abuse intervention and victim assistance services available in the community and their level of accessibility in order to make appropriate referrals.

* Offer to train the staff of abuse intervention and victim assistance programs on making their services and facilities accessible to persons with physical, mental, and sensory disabilities.

* Invite battered women's programs to train staff on strategies for assisting people with disabilities in abusive situations.

* Collaborate with abuse intervention programs to train other service providers, such as law enforcement and medical and social service professionals, on the particular needs of people with disabilities who are experiencing abuse.

* Include abuse screening questions as a routine part of intake and follow-up procedures.

* Display awareness-raising posters and include in a resource library materials on abuse intervention.

* Include safety planning as a part of peer counseling services.

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Margaret A. Nosek, Ph.D.
Principal Investigator

Rosemary B. Hughes, Ph.D.
Project Director

Carol Howland
Project Director

Heather Taylor, Ph.D.
Investigator

Mary Ellen Young, Ph.D.
Investigator

Catherine Clubb Foley, Ph.D.
Investigator

Laurie Walter, Ph.D.
Statistician

Ellen Grabois, J.D., L.L.M.
Investigator

Beth Mastel-Smith, M.S.N.
Research Associate

Nancy Swedlund, Psy.D.
Post-Doctoral Fellow

Kym I. King
Communications Director


With grateful appreciation for our support staff:

Kathy Meroney
Nancy Womack
Graciela Wright
Joyce White
Kathy Fire
Sherry White
Miriam Espitia
Martha Mendez

And our consultants:

Patricia D. Mullen, Dr. P.H.
University of Texas, Houston, School of Public Health
Janet Y. Groff, M.D., Dr. P.H.
University of Texas, Houston, Medical School
Judith McFarlane, R.N., Dr. P.H., F.A.A.N.
Texas Women's University

This research was supported by funding from the Centers for Disease Control and Prevention (R04/CCR614142), the National Institute on Disability and Rehabilitation Research (H133A60045), and the National Center for Medical Rehabilitation Research at the National Institutes of Health (HD30166).

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