Survey of Rehabilitation Service Providers' Perceived Knowledge and Confidence in Dealing with Abuse of Women with Disabilities
The purpose of this study was to assess the self-reported ability of rehabilitation service providers to identify women in abusive situations and to refer them to appropriate community resources. As primary service providers to women with disabilities living in the community, rehabilitation counselors and independent living specialists have the opportunity to recognize abusive situations and to initiate the interventions that can bring about change. Women who come to them for services related to vocational or independent living needs may have experienced or may be experiencing abusive situations. A woman's experience of abuse at the hands of partners, family members, or personal care attendants may have deleterious effects on her achievement of vocational or independent living goals. Rehabilitation and independent living counselors may not be adequately trained to recognize abusive situations nor to identify or access resources to assist women in dealing with these issues. The research questions underlying this study were:
- Do rehabilitation counselors and independent living specialists report that they are able to recognize the signs of abuse among the women they serve?
- Do rehabilitation counselors and independent living specialists report that they know what to do when they identify a women who is being or has been abused?
- Do rehabilitation counselors and independent living specialists believe that abuse of women with disabilities is a barrier to the achievement of rehabilitation and independent living goals?
A cross-sectional survey design was used. A survey instrument containing items related to various aspects of abuse and the effect of abuse on the attainment of rehabilitation and independent living goals was designed by the project staff based on the literature, input from members of the national advisory panel, and input from collaborators at the National Rehabilitation Association (NRA) and the National Association of Rehabilitation Professionals in the Private Sector (NARPPS). The survey consisted of questions pertaining to the following areas (refer to Table 1 below for specific wording of the questions):
- Importance of the problems of family violence and sexual assault of women with disabilities (Questions 1 & 2)
- The self-reported knowledge that rehabilitation counselors and independent living specialists have about the signs of abuse and the places to refer women who experience abuse in their communities (Questions 3 & 4)
- The degree to which rehabilitation counselors and independent living specialists believe it is their responsibility to address abuse issues and ask their clients about family violence and other types of abuse (Questions 5 & 6)
- The comfort level rehabilitation counselors and independent living specialists have in their skills in dealing with abuse (Question 7)
- Their belief that abuse interferes with the achievement of vocational and independent living goals (Question 8)
- The need for information and additional training in abuse prevention and intervention strategies (Questions 9 & 10)
- The percentage of women served who have discussed abuse with the rehabilitation counselors and independent living specialists being surveyed
There were also items related to the participants' demographic characteristics (age, gender, education, minority status, and disability status), licensure or certification, primary population served, and work setting.
The sample was randomly selected from three sources. First, we used the ILRU National Directory of Independent Living Centers, a listing of 530 programs. Second, from the National Rehabilitation Association (NRA) membership list of 13,000 professionals in the field of rehabilitation, a randomly selected list of 1,255 was generated. Third, 1,000 names were randomly selected from the membership list of the National Association of Rehabilitation Professionals in the Private Sector (NARPPS) of about 4,000 rehabilitation counselors, rehabilitation nurses, and case workers, with less than 5% overlap with NRA. The number of returned surveys was 624, for a 22% response rate. Thirteen percent were employed in a state vocational rehabilitation agency, 57% in other vocational rehabilitation settings such as the office of private rehabilitation providers or hospitals, and 30% in independent living centers.
Three quarters of the rehabilitation service providers surveyed indicated that they were aware of the importance of the problem of abuse of women with disabilities. A similar proportion believed that they could recognize the signs of abuse and over ninety percent of them knew where in their community to refer women with disabilities who have experienced abuse. Eighty percent of the sample believed it was within their job responsibilities to deal with their clients' abuse issues, 74 percent indicated that they were comfortable responding to abuse issues, and almost all respondents (95 percent) indicated that abuse of a woman with a disability interferes with her vocational or independent living goals.
In spite of these high percentages of responses indicating a knowledge of and confidence in dealing with abuse issues, only 19 percent of the survey respondents indicated that they routinely ask about abuse. This inclusion of routine screening in a respondent's practice is significantly correlated with the approximate percent of women with disabilities who had discussed their abuse experiences with the respondents in the past year. In other words, those who asked about abuse, found abuse. Those who did not ask, did not find it.
It is especially disturbing that the prevalence reports of abuse by respondents are so low, with 20 percent having no discussions about abuse with their clients at all in the past year, and over three quarters of the respondents discussing abuse issues with 10 % or fewer of their clients. If, as was found in our earlier study, approximately half of the women with physical disabilities have experienced physical or sexual abuse, the survey respondents are overlooking the likelihood that abusive experiences have been having a negative impact on their clients' achievement of vocational or independent living goals.
Respondents overwhelmingly indicated that they would like more information about abuse prevention and intervention strategies for women with disabilities, and most of them indicated they would attend a training session on such topics. Of great interest is the finding that there are differences in their sensitivity to abuse issues based on their work settings and credentials. Those employed in independent living centers had higher scores that those who worked in the state vocational rehabilitation agencies. Those who worked in other rehabilitation settings had the lowest scores of all three groups. Those respondents with rehabilitation certification had the lowest mean scores compared to those with other types of licensure or certification and even to those with no licensure or certification at all.
These findings reveal the substantial need for information and training on abuse issues by rehabilitation service providers no matter what their work setting. Of paramount concern is that those with rehabilitation certification are not as sensitive as their counterparts with other or even no credentials. This most likely reflects a lack of emphasis on abuse issues in the educational or experiential components required for rehabilitation certification. This deficiency needs to be addressed by those responsible for rehabilitation training and certification.
The findings of this study need to be interpreted with caution because of the self-report nature of the study, low response rate and the sample biases. The low response rate might be the result of nonresponse by those who are not sensitive to abuse issues. In other words, those who believed that abuse was not a problem for women with disabilities might have chosen to not answer the survey, rather than answering it in a manner reflecting this belief system. The sample is biased in that it was predominately female and white. This may reflect gender and ethnicity biases inherent in the populations from which the random sample was drawn or it may reflect gender or ethnic bias in the willingness to complete the survey. Although it may be hypothesized that women are more sensitive to the issues of abuse in women with disabilities, gender was not significant in accounting for differences in responses. Another concern is that state vocational rehabilitation counselors were underrepresented in the sample, even though the largest number of surveys were sent to those sampled from the National Rehabilitation Association mailing list. Those employed by state vocational rehabilitation agencies may have chosen not to respond to the survey for any number of reasons that cannot be determined.
It has been established that women with physical disabilities experience a high prevalence of lifetime exposure to emotional, physical and sexual abuse. Estimates for current abuse is approximately 13%, mirroring the experiences of women in general in our society. Disabilities, however, expose women to different perpetrators of abuse and they are likely to experience the abuse for longer periods of time than women without disabilities (Young, et al., 1997). Rehabilitation service providers who have contacts with women with disabilities have an opportunity for assessment of their clients' safety and an obligation to initiate an intervention. The finding that service providers do not routinely ask about abuse or violence may be explained by reasons similar to those described for physicians (Salber & Taliaferro, 1995).
In order to address the abuse and violence in the lives of women with disabilities, every service provider has the responsibility to (1) be knowledgeable in issues of sexual assault and family violence, (2) know the resources in their community for dealing with abuse experiences, (3) form linkages with victim assistance providers, (4) include safety screening as a routine part of their client intake and follow up procedures, and (5) provide information, resources, and referrals to clients who are in abusive situations or who have experienced abuse in their lives. Rehabilitation service providers are primary points of service delivery for many women with disabilities. Other points of contact include physician visits, as well as contact with other medical and social service providers. The issue of abuse can be dealt with only if all service providers use their contact opportunities to ask every client if he or she is safe and to ask specifically if he or she is experiencing or has experienced abuse or violence at any time in the past. If the question is not asked, the problem will not be identified and the service provider becomes another perpetrator of the veil of silence surrounding this problem.
The results of this study also document the need for additional training and information on abuse for rehabilitation service providers. For pre-service education, specific content areas on abuse should be added to the curriculum required by the Commission on Rehabilitation Education (CORE) for masters degree programs in rehabilitation counseling. Supervised practica and internship experiences should include opportunities to work with clients who have experienced abuse. Service providers who are already employed should be required to participate in in-service training on abuse-related topics such as the prevalence of abuse among disability populations, abuse screening, the signs of abuse, community resources available to deal with abuse issues, and barriers faced by women with disabilities when they seek help for problems related to abusive situations.
In light of the astounding findings that those service providers who have rehabilitation certification demonstrated the lowest scores on sensitivity to abuse issues, compared with providers who have other types of credentials or no certification/licensure at all, it is strongly recommended that the Commission on Rehabilitation Counselor Certification (CRCC) evaluate its certification requirements--including those pertaining to education, experience, and examination. Where appropriate, modifications should be made in the certification process to assure that those who achieved this level of professional achievement are well prepared to help their clients recognize and deal with the issues of abuse and violence in their lives.
Finally, it is recommended that rehabilitation service agencies incorporate abuse screening into their standard assessment and in-take procedures. These agencies should provide on-going in-service training opportunities for their service providers and also should establish effective linkages with community agencies that provide services to people who are dealing with abuse in their lives.
Based on excerpts from Young ME, Nosek MA, Walter LJ, Howland CA (1998). A survey of rehabilitation service providers' perceived knowledge and confidence in dealing with abuse of women with disabilities. Center for Research on Women with Disabilities, Baylor College of Medicine, Houston, TX.