VAWnet Applied Research Forum National Electronic Network on Violence Against Women
Abuse and Women with Disabilities Margaret A. Nosek, Ph.D. and Carol A. Howland, M.P.H. Revised February 1998 Defining Disability and Abuse For the purpose of this paper, the term disability will encompass the following impairments: disability that can increase vulnerability to abuse resulting from physical, sensory, or mental impairments, or a combination of impairments; physical disability resulting from injury (e.g., spinal cord injury, amputation), chronic disease (e.g., multiple sclerosis, rheumatoid arthritis), or congenital conditions (e.g., cerebral palsy, muscular dystrophy); sensory impairments consisting of hearing or visual impairments; and mental impairments comprising developmental conditions (e.g., mental retardation), cognitive impairment (e.g., traumatic brain injury), or mental illness. Emotional abuse is being threatened, terrorized, severely rejected, isolated, ignored, or verbally attacked. Physical abuse is any form of violence against one’s body, such as being hit, kicked, restrained, or deprived of food or water. Sexual abuse is being forced, threatened, or deceived into sexual activities ranging from looking or touching to intercourse or rape. Prevalence of Violence Against Women with Disabilities The prevalence of abuse among women in general has been fairly well documented, yet only a few North American studies (review by Sobsey, Wells, Lucardie, & Mansell, 1995), primarily from Canada, have examined the prevalence among women with disabilities. The DisAbled Women’s Network of Canada
(Ridington, 1989) surveyed 245 women with disabilities and found that 40% had experienced abuse; 12% had been raped. Perpetrators of the abuse were primarily spouses and ex-spouses (37%) and strangers (28%), followed by parents (15%), service providers (10%), and dates (7%). Less than half these experiences were reported, due mostly to fear and dependency. Ten percent of the women had used shelters or other services, 15% reported that no services were available or they were unsuccessful in their attempts to obtain services, and 55% had not tried to get services. Sobsey and Doe (1991) conducted a study of 166 abuse cases handled by the University of Alberta’s Sexual Abuse and Disability Project. The sample was 82% women and 70% persons with intellectual impairments, and covered a very wide age range (18 months to 57 years). In 96% of the cases, the perpetrator was known to the victim; 44% of the perpetrators were service providers. Seventy-nine percent of the individuals were victimized more than once. Treatment services were either inadequate or not offered in 73% of the cases. The Ontario Ministry of Community and Social Services (Toronto Star, April 1, 1987) surveyed 62 women and found that more of the women with disabilities had been battered as adults compared to the women without disabilities (33% versus 22%), but fewer had been sexually assaulted as adults (23% versus 31%). An extensive assessment of the sexuality of noninstitutionalized women with disabilities, which included comprehensive assessment of emotional, physical, and sexual abuse, was conducted by the Center
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VAWnet Applied Research Forum for Research on Women with Disabilities (CROWD) through a grant from the U.S. National Institutes of Health. This study also covered other areas that may be associated with abuse, such as sexual functioning, reproductive health care, dating, marriage, parenting issues, and the woman’s sense of self as a sexual person. The design of the study consisted of (1) qualitative interviews with 31 women with disabilities, and (2) a national survey of 946 women, 504 of whom had physical disabilities and 442 who did not have disabilities. Disabilities reported most frequently included spinal cord injury, cerebral palsy, muscular dystrophy, multiple sclerosis, and joint and connective tissue diseases. Abuse issues emerged as a major theme among the 31 women interviewed in the first phase of this study. An analysis of reports of abuse in those interviews was described by Nosek (1996). Twenty-five of the 31 women reported being abused in some way. Of 55 separate abusive experiences, 15 were reported as sexual abuse, 17 were physical (nonsexual) abuse, and 23 were emotional abuse. The findings from the qualitative study were used to develop items for the national survey. Two pages of the 51-page survey were devoted to abuse issues, encompassing more than 80 variables, including type of abuse by perpetrator and age when abuse began and ended, plus two open-ended questions. Analyses of these data (Young, Nosek, Howland, Chanpong, & Rintala, 1997) have revealed that abuse prevalence (including emotional, physical and sexual abuse) was the same (62%) for women with and without disabilities. There were no significant differences between percentages of women with and without disabilities who reported experiencing emotional abuse (52% versus 48%), physical abuse (36% in both groups), or sexual abuse (40% versus 37%). The most common perpetrators of emotional and physical abuse for both groups were husbands, followed by mothers, then fathers. Emotional abuse by husbands was reported by 26% of all women in both groups; physical abuse by husbands was
reported by 17% of all women with disabilities and 19% of all women without disabilities. The most common perpetrator of sexual abuse was a stranger, as reported by 11% of women with disabilities and 12% of women without disabilities. Women with disabilities were significantly more likely to experience emotional and sexual abuse by attendants and health care workers. Women with disabilities reported significantly longer durations of physical or sexual abuse compared to women without disabilities (3.9 years versus 2.5 years). In an analysis of sexual functioning, abuse was found to be a significant predictor of lower levels of satisfaction with sex life among women with disabilities (Nosek, Rintala, Young, Howland, Foley, Rossi, & Chanpong, 1995) Others have reported a history of sexual abuse among 25% of adolescent girls with mental retardation (Chamberlain, Rauh, Passer, McGrath, & Burket, 1984), 31% of those with congenital physical disabilities (Brown, 1988), 36% of multihandicapped children admitted to a psychiatric hospital (Ammerman, Van Hasselt, Hersen, McGonigle, & Lubetsky, 1989), and 50% of women blind from birth (Welbourne, Lipschitz, Selvin, & Green, 1983). In spite of these high percentages, few women receive treatment from victim services specialists (Andrews & Veronen, 1993). Abuse Interventions for Women with Disabilities There have been virtually no studies that examine the existence, feasibility, or effectiveness of abuse interventions for women with disabilities. In both the disability rights movement and the battered women’s movement, it is generally acknowledged that programs to assist abused women are often architecturally inaccessible, lack interpreter services for deaf women, and are not able to accommodate women who need assistance with daily self-care or medications (Nosek, M.A., Howland, C.A., & Young, M.E. 1998). Merkin and Smith (1995), in discussing the needs of deaf
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VAWnet Applied Research Forum women, state that counseling is more effective when sensitive to deaf culture issues and appropriate communication techniques. Crisis interventions typically include escaping temporarily to a woman’s shelter, having an escape plan ready in the event of imminent violence if the woman chooses to remain with the perpetrator, and escaping permanently from the abuser. These options may be problematic for the woman with a disability if the shelter is inaccessible or unable to meet her needs for personal assistance with activities of daily living, if the shelter staff are unable to communicate with a deaf or speech-impaired woman, if she depends primarily on the abuser for assistance with personal needs and has no family or friends to stay with, or if she is physically incapable of executing the tasks necessary to implement an escape plan such as packing necessities, hiding money, and driving or arranging transportation to a shelter or friend’s home. Andrews and Veronen (1993) list four requirements for effective victim services for women with disabilities. First, service providers need to provide adequate assessment of survivors, including questions about disability-related issues. Second, abuse service providers should be trained to recognize and effectively respond to needs related to the disability, and disability service providers should be trained in recognizing and responding to physical and sexual trauma. Third, barriers to services should be eliminated by providing barrier-free information and referral services, by ensuring physical accessibility to facilities, by providing 24-hour access to transportation, to interpreters, and to communication assistance, and by providing trained personnel to monitor risks and respond to victims receiving services through disability programs. Finally, persons with disabilities who are dependent on caregivers, either at home or in institutions, may need special legal protection against abuse. The National Domestic Violence Hotline keeps a database of battered women’s shelters
throughout the country, with indications of their architectural accessibility and the availability of interpreter services. Although the hotline is equipped with telecommunication devices for persons who are deaf, it is rarely used. The National Coalition Against Domestic Violence has issued a manual that gives specific guidelines for battered women’s programs on implementing accessibility modifications according to the requirements of the Americans with Disabilities Act and increasing sensitivity and responsiveness among program staff to the needs of abused women with disabilities (National Coalition Against Domestic Violence, 1996). Critique of Studies on Abuse and Disability Until recently, the problem of abuse among people with disabilities has received very little attention. Early studies suffered from many methodological weaknesses. Essential constructs and variables important to statistical analysis were rarely defined. There was a particular lack of distinction among emotional, physical, and sexual abuse. The studies used unstandardized measurement instruments and techniques. Global references were made to the type of abuse, for example, emotional versus sexual; however, there was little attempt to document or categorize specific incidents by perpetrator. Samples in these studies were generally quite heterogeneous in terms of disability type, gender, and age. There was also the use of convenience sampling, such as using clients of intervention programs or police reports, as opposed to representative or random sampling. Statistical analyses rarely go beyond frequencies and measures of central tendency. Due to the heterogeneity of the samples, analyzing specific experiences of individuals with specific characteristics (such as sexual abuse among adult women with mental illness) would result in subsamples too small to allow the use of more sophisticated analytic procedures. The recent study by the Center for Research
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VAWnet Applied Research Forum on Women with Disabilities addressed a number of these issues. It had clearly defined variables; assessed types of abuse, perpetrator, and duration of abuse; sampled a broad range of women nationwide, including an able-bodied comparison group; and was restricted to a defined sample of adult women with physical disability. The issue of designing and implementing appropriate intervention studies for women with disabilities has received no attention beyond observation and speculation. Conclusion There is no question that abuse of women with disabilities is a problem of epidemic proportions that is only beginning to attract the attention of researchers, service providers, and funding agencies. The gaps in the literature are enormous. For each disability type, different dynamics of abuse come into play. For women with physical disabilities, limitations in physically escaping violent situations are in sharp contrast to women with hearing impairments, who may be able to escape but face communication barriers in most settings designed to help battered women. Certain commonalities exist across disability groups, such as economic dependence, social isolation, and the whittling away of self-esteem on the basis of disability as a precursor to abuse. Research that employs methodologic rigor must be conducted with women who have disabilities such as blindness, deafness, mental illness, and mental retardation. Particular attention must be paid to identifying vulnerability factors that are disabilityrelated as opposed to those factors experienced by all women. We must know more about interventions that are effective for women with disabilities. Considerable work has been done in this area for women in general; however, many of the recommended strategies are not feasible for women with disabilities. Few of the strategies listed in classic safety plans are possible for women who must depend on their abuser to get them out of bed
in the morning, dress them, and feed them. There are only a handful of programs across the country that specifically address the needs of abused women with disabilities, making controlled intervention studies very difficult. Much more work must be done to increase the awareness of providers of disability-related services so that they can recognize abuse among their clients and make appropriate referrals to battered women’s programs. Correspondingly, much more work must be done to increase the capacity of battered women’s programs to serve women with all types of disabilities. Authors of this document: Margaret A. Nosek, Ph.D. Carol A. Howland, M.P.H.* (*Candidate working on thesis, all other requirements completed)
References Ammerman, R. T., Van Hasselt, V. B., Hersen, M., McGonigle, J. J., & Lubetsky, M. J. (1989). Abuse and neglect in psychiatrically hospitalized multihandicapped children. Child Abuse & Neglect, 13, 335-343. Andrews, A. B., & Veronen, L. J. (1993). Sexual assault and people with disabilities. Special issue: Sexuality and disabilities: A guide for human service practitioners. Journal of Social Work and Human Sexuality, 8(2), 137-159. Asch, A., & Fine, M. (1988). Introduction: Beyond Pedestals. In: Fine, M., & Asch, A. (Eds.) Women with disabilities: Essays in psychology, culture, and politics. Philadelphia, PA: Temple University Press. Brown, D. E. (1988). Factors affecting psychosexual development of adults with congenital physical disabilities. Physical and Occupational Therapy in Pediatrics, 8(2-3), 43-58.
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VAWnet Applied Research Forum Chamberlain, A., Rauh, J., Passer, A., McGrath, M., & Burket, R. (1984). Issues in fertility control for mentally retarded female adolescents I: Sexual activity, sexual abuse, and contraception. Pediatrics, 73, 445-450. Merkin, L., & Smith, M. J. (1995). A community based model providing services for deaf and deafblind victims of sexual assault and domestic violence. Sexuality and Disability, 13(2), 97-106. National Coalition Against Domestic Violence. (1996). Open minds, open doors: Technical assistance manual assisting domestic violence service providers to become physically and attitudinally accessible to women with disabilities. Denver, CO: National Coalition Against Domestic Violence. Nosek, M.A. (1996). Sexual abuse of women with physical disabilities. In D. M. Krotoski, M. A. Nosek, & M. A. Turk (Eds.), Women with physical disabilities: Achieving and maintaining health and well-being. (pp. 153-173). Baltimore, MD: Paul H. Brookes. Nosek, M.A. (1996). Wellness among women with physical disabilities. In D. M. Krotoski, M. A. Nosek, & M. A. Turk (Eds.), Women with physical disabilities: Achieving and maintaining health and well-being. (pp. 17-33). Baltimore, MD: Paul H. Brookes.
Ontario Ministry of Community and Social Services. (1987). Disabled women more likely to be battered, survey suggests. The Toronto Star, April 1, F9 Ridington, J. (1989). Beating the “odds”: Violence and women with disabilities (Position Paper 2). Vancouver: DisAbled Women’s Network: Canada. Sobsey, D., Wells, D., Lucardie, R., & Mansell, S. (Eds.) (1995). Violence and disability: An annotated bibliography. Baltimore, MD: Paul H. Brookes. Sobsey, D., & Doe, T. (1991). Patterns of sexual abuse and assault. Sexuality and Disability, 9(3), 243-260. Welbourne, A., Lipschitz, S., Selvin, H., & Green, R. (1983). A comparison of the sexual learning experiences of visually impaired and sighted women. Journal of Visual Impairment and Blindness, 77, 256-259. Young, M.E., Nosek, M.A., Howland, C.A., Chanpong, G., Rintala, D.H: (1997) Prevalence of abuse of women with physical disabilities. Archives of Physical Medicine and Rehabilitation Special Issue. 78 (12, Suppl. 5) S34-S38
Nosek, M.A., Howland, C.A., & Young, M.E. (1998). Abuse of Women with Disabilities: Policy Implications. Journal of Disability Policy Studies 8 (1,2), 158-175. Nosek, M.A., Rintala, D.H., Young, M.E., Howland, C.A., Foley, C.C., Rossi, C.D., & Chanpong, G. (1995). Sexual functioning among women with physical disabilities. Archives of Physical Medicine and Rehabilitation, 77, (2), 107-115. Abuse and Women with Disabilities (Rev. 2/10/98) VAWnet is a project of the National Resource Center on Domestic Violence 800-537-2238 TTY 800-553-2508 Fax 717-545-9456
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Applied Research Forum National Electronic Network on Violence Against Women
In Brief: Abuse and Women with Disabilities Prevalence of Abuse among Women with Disabilities ·
Sixty-two percent of a national sample of women with physical disabilities reported having experienced emotional, physical, or sexual abuse. The same percentage of a comparison group of women without disabilities reported abuse, but the women with disabilities had experienced abuse for longer periods of time.
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The most common perpetrators of abuse were husbands and parents for both women with and without disabilities. Women with disabilities, however, were significantly more likely to experience emotional and sexual abuse by attendants and health care workers.
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In addition to the types of abuse experienced by all women, women with physical disabilities are sometimes abused by withholding needed orthotic equipment (wheelchairs, braces), medications, transportation, or essential assistance with personal tasks, such as dressing or getting out of bed.
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Others have reported a history of sexual abuse among 25% of adolescent girls with mental retardation, 31% of those with congenital physical disabilities, 36% of multihandicapped children admitted to a psychiatric hospital, and 50% of women blind from birth.
Interventions for Abused Women with Disabilities ·
There have been no studies that examine the existence, feasibility, or effectiveness of abuse interventions for women with disabilities.
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Women with disabilities face serious barriers to accessing existing programs to help women remove violence from their lives. In both the disability rights movement and the battered women’s movement, it is generally acknowledged that programs to assist abused women are often architectually inaccessible, lack interpreter services for deaf women, and are unable to assist women who need assistance with daily self care or medications.
Recommendations for Research and Program Development ·
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.
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Make all services offered by battered women’s programs (e.g., hot lines, individual counseling, support groups) fully accessible and integrated for women with disabilities.
In Brief: Abuse and Women with Disabilities (Rev. 2/10/ 98) VAWnet is a project of the National Resource Center on Domestic Violence 800-537-2238 TTY 800-553-2508 Fax 717-545-9456
VAWnet Applied Research Forum Recommendations for Research and Program Development (con’t.) ·
Provide, or refer to, legal assistance for obtaining restraining orders and managing court systems which is accessible to women with disabilities.
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Keep statistics on the number of women with disabilities who call crisis hot lines or use other program services.
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Assist and encourage police in recording disability status in their crime reports, as well as encouraging adoption of a separate category for perpetrators who are caregivers.
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Offer training to disability-related service providers, including independent living centers and churches, on recognizing the symptoms of abuse and the characteristics of potential batterers. They should be familiar with, and able to refer to, resources for battered women in their community.
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Train staff on how to communicate with persons who have hearing, cognitive, speech, or psychiatric impairments. They should understand environmental barriers faced by women with physical and sensory disabilities when offering advice or referrals for obtaining shelter.
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Have on hand an extensive network of community referrals and contact numbers, including volunteers or other community resources for obtaining personal assistance.
This In Brief highlights issues discussed in a longer document created by Margaret Nosek and Carol Howland and is available through your state domestic violence coalition. In Brief: Abuse and Women with Disabilities VAWnet is a project of the National Resource Center on Domestic Violence 800-537-2238 TTY 800-553-2508 Fax 717-545-9456
(Rev. 2/10/98)
Providing Domestic Violence Services to Persons with Disabilities Domestic violence is a serious health issue for women in North Carolina, including women with disabilities. According to the 2000 U.S. Census, 21.1 % of adult women in our state have a disability. Some women with disabilities are at higher risk for domestic violence and sexual assault than women without disabilities. Nationally, about 85% of women with disabilities have experienced domestic violence (Feuerstein, 1997). Research also suggests women with disabilities may experience longer durations of abuse (Young et al., 1997).
Risk Factors for Violence for Persons with Disabilities There are many risk factors for violence for women with disabilities. Persons who are deaf or who have a speech disability may not be able to report abuse or seek services due to communication barriers. Individuals with intellectual disabilities often reside in group homes where they are vulnerable to abuse by staff, caregivers or other residents. They are often taught to be obedient and may be overly trusting of others. Persons with physical disabilities may depend on others to meet their basic needs such as bathing or toileting, making them vulnerable to abuse. They may also be less able to defend themselves or escape violent situations. Women with disabilities may lack knowledge about their bodies, healthy relationships, and how to protect themselves (Disability Services ASAP of SafePlace in Austin, Texas).
The Americans with Disabilities Act The Americans with Disabilities Act (ADA) is a civil rights law, passed in 1990, that guarantees equal opportunity for individuals with disabilities. The law requires agencies to make reasonable modifications as necessary to make the facilities, services, or programs accessible to people with disabilities. Each person who has a disability has unique needs in order to access services. Domestic violence agencies should be prepared to make necessary accommodations in order to provide the same services.
Staff and Volunteer Sensitivity to Persons with Disabilities Staff and volunteers at domestic violence agencies need to become aware of strategies to effectively interact with persons with disabilities. For example, using appropriate language can foster positive attitudes. One suggestion for communicating with and about people with disabilities is "people-first" language, which emphasizes the person, not the disability. It is preferred to say, "people with disabilities" instead of "the disabled." By placing the person first, the disability is no longer the primary defining characteristic of an individual but one of several aspects of the whole person. It refers to the person first and then to the
situation or disability, if it’s relevant. People first language is respectful, and it addresses people as individuals. Other communication tips include how to offer assistance to a person with a disability. First, ask the person if she needs any help. If the offer is accepted, then listen for specific instructions about the best way to provide assistance. When talking with someone who has a disability, speak directly to that person rather than through a companion who may be present. Don’t be embarrassed if you use accepted, common expressions such as "See you later" or "Got to be running along" that seem to relate to the person’s disability. It’s okay to say these, even around persons with vision loss or mobility limitations. Remember to be considerate of the extra time it might take for a person with a disability to get things done or said. Let the person set the pace in walking and talking.
Recommendations for Making Domestic Violence Programs and Services Available and More Accessible for Individuals with Disabilities (Adapted from Disability Services ASAP (A Safety Awareness Program of Austin, Texas)
Physical Accessibility • Make accessible the building's entrance, doorways, hallways, restrooms, and areas where services are delivered. Keep spaces clear of objects or furniture that could pose barriers for persons who use a wheelchair, cane, or other mobility devices. • Locate accessible parking spaces closest to the accessible entrance. • Provide a ramp or non-step entrance and curb cuts at sidewalks. • Install accessible handles or levers (operable with a closed fist) on doors. • Include raised letters or Braille on signs within the building. • Equip at least one restroom with grab bars, adequate space for a wheelchair, and access to the sink (including levers on the faucets). • Install smoke alarms with flashing lights and audible sounds. Counseling • Allow additional time or counseling sessions for clients with disabilities if needed. • Offer flexibility/patience in goal planning with persons who have difficulty articulating/determining their needs. Communication • Hire sign language interpreters or facilitate clear communication for intake and counseling sessions as needed. • Offer materials in alternate formats (large print, simplified language, audio cassette, diskette). • Assist clients needing help with correspondence, completing forms, or making telephone calls.
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Ensure that a telephone is equipped with a TTY (telecommunication device for the Deaf) and that staff/volunteers are familiar with relay services (operator-assisted service allowing communication between a TTY user and a non-user). Have a telephone with volume control for clients who are Hard of Hearing.
General • Allow service animals within the agency. These animals are not pets, but are specifically trained to assist with mobility, tasks, or alerts. • Target people with and without disabilities for community education and outreach. • Include disability information and resources during staff / volunteer training. • Actively recruit staff and volunteers with disabilities. • Make volunteer opportunities accessible for people with disabilities (i.e., training materials available in alternate formats, training sessions held in physically accessible locations.) • Make accessible transportation available for clients with disabilities needing services. Considerations within Shelter Settings • Ask the individual to identify their needs as well as assistance they prefer. • Include a line item in agency's budget to hire short-term personal care attendants and interpreters when needed. • Adopt and implement a policy to allow a client's personal care attendant or friend to come to shelter to provide personal care services. • Adapt agency rules (i.e. extend personal phone time for persons who use a TTY, allow persons who have a mental health disability to have their own bedroom). In summary, domestic violence programs and services need to provide accessible services to all women, including women with disabilities. Information and communication channels such as printed materials and hotlines / intake should be accessible. All clients should be asked in they will need any type of assistance or accommodation while receiving services. Domestic violence offices and shelters should be physically accessible, especially the entrance, restroom and bedroom (shelters). Staff and volunteers need ongoing disability training to enhance knowledge and sensitivity so that agencies can provide inclusive and disability-friendly services.
Brief Guide for Sexual and Domestic Violence Agencies
Americans with Disabilities Act
Overview
The Americans with Disabilities Act (ADA) was signed into federal law on July 26, 1990. The purpose of the ADA is to prohibit discrimination and ensure equal opportunities for persons with disabilities. People with disabilities experience sexual and domestic violence at the same or higher rates as the general public. Every community includes people with disabilities, yet they are underrepresented in sexual and domestic violence victim service reports. This fact sheet offers Sexual & Domestic Violence Agencies the legal guidelines for providing accessible services as defined by the ADA. As with any underserved population, the first step toward true accessibility is learning about that community and changing our attitudes.
How does the ADA define “disability?” 1)
Individuals who have a physical or mental impairment that substantially limits one or more major life activities. • Major life activities include such activities as caring for one’s self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning & working.
2)
Individuals who have a record of a physical or mental impairment that substantially limits one or more of the individual’s major life activities; including: • Person who has a history of an impairment but has recovered from it. • Person who has been misdiagnosed as having an impairment.
3)
Individuals who are regarded as having such an impairment, whether they have the impairment or not. • One who has an impairment that does not substantially limit him/her, but is treated as if it does (e.g. a person who has schizophrenia that is controlled by medication, yet is not allowed to participate in a support group);
• One who has an impairment that substantially limits major life activities only as a result of the attitudes of others towards the impairment (e.g. someone denied shelter because she has cerebral palsy, although she can care for herself);
• One who has no impairments but who is treated like s/he has an impairment that substantially limits a major life activity (e.g. someone who is believed to be HIV+ but is not).
Titles of the ADA Title I :
Employment
Title II:
State/local government and transportation
Title III:
Private businesses, non-profits
Title IV:
Telecommunications
Title V:
Miscellaneous
Which titles apply to Sexual & Domestic Violence Agencies? • ALL SDVAs operating under a local government agency are covered under Title II. • ALL SDVAs that are non-profits, including those in umbrella non-governmental agencies, are under Title III. • Any agency with 15 or more employees must comply with Title I when employing a person with a disability.
Overview of Requirements Below are requirements in both Title II and Title III. All agencies must:
Not refuse, due solely to a disability, to allow a person to receive your services. Make reasonable modifications in policies, practices and procedures that would otherwise deny a person with a disability equal access to services, UNLESS the modification would fundamentally alter the services. Integrate a person with a disability into your agency services, unless providing separate services is the only way to provide equal opportunities for services. Persons with disabilities cannot be required to participate in separate services. Not directly ask about one’s disability, but may ask about needed accommodations. Not charge persons with disabilities to cover the costs of needed accommodations.
Allow service and companion animals in facilities unless the animal poses a direct threat to the health/safety of others. Eliminate unnecessary eligibility rules that deny persons with disabilities services (e.g., requiring a driver’s license as ID; screening out persons using medications). Requiring proof of disability is not allowed. Provide auxiliary aids/services when they are necessary to ensure effective communication UNLESS doing so would cause an undue burden (“significant difficulty or expense”) or fundamental alteration in services. (Auxiliary services could include reading a brochure to a survivor if providing it in Braille is too expensive) Deny a person services ONLY if s/he poses a direct threat (i.e. a significant risk to the health or safety of others that cannot be eliminated through modifications to policies, procedures or services).
The ADA describes the bare minimum for providing services to people with disabilities. Advocates are encouraged to go beyond these minimum guidelines to provide the most accessible services possible.
Facility Accommodations Title II Programs in Local Government
Title III Non-profit Programs
Existing Construction The first priority should be removing barriers so a person with a disability can “get in the front door.” Must ensure that persons with disabilities are not excluded from services because buildings are inaccessible. Need not remove physical barriers (e.g., stairs) in all buildings as long as the agency makes the services accessible to persons unable to use the inaccessible location: • May provide the service in another location • May provide a personal assistant • May not carry a person up stairs When an agency alters an existing building, it must ensure that the altered portions are accessible.
Architectural (physical elements of the building) and communication (e.g. signs, alarms) barriers to entering and using existing program locations must be resolved when “readily achievable.” • “Readily achievable” means “easily accomplishable and able to be carried out without much difficulty or expense.” • “Readily achievable” is determined case-by-case based on resources available. Alterations to existing buildings must be accessible to the maximum extent feasible.
New Construction Do not assume your contractor is familiar with the ADA. There are very specific rules related to new construction and alterations. Refer to the ADA Accessible Guidelines for Building and Facilities for specific information before undergoing construction or alterations. Agencies must ensure that newly constructed buildings are free of architectural and communication barriers that restrict access or use by persons with disabilities.
All newly constructed places must be accessible to persons with disabilities unless it is structurally impracticable (i.e., building on stilts in a marshland).
ADA Complaints
Persons who believe they have been discriminated against by a Title II or III entity due to a disability can file a complaint with the U.S. Department of Justice Civil Rights Division or file a personal case in U.S. District Court. A finding of an ADA violation by the Department of Justice may be handled in any of the following ways, depending on the pattern or type of discrimination: • Legal action in U.S. District Court • Mediation • Out-of-court settlement • Provision of technical assistance
Legal Notice
The information provided in this brochure should not be construed as legal advice nor used as such. Nor is this resource meant to encompass all ADA guidelines. If you have a legal question related to the ADA or other disability rights laws, please contact an attorney, or one of the resources listed below.
Case Law
ADA and similar disability-rights legal cases are often taken to court. The results of these cases often create “case law” which further interprets the ADA and can help to clarify sections of the ADA that seem vague. See Resources below if you have a question regarding case law.
Defining disability is not always clear: Drug and Alcohol Abuse: Drug addiction is an impairment under the ADA. However, services
can be withheld if an addict is illegally using controlled substances. Persons who have been rehabilitated or are in a treatment program and no longer using drugs are protected. Persons who are incorrectly perceived to be under the influence of illegal drugs are protected under the ADA. Alcohol is not a controlled substance, but alcoholism can be considered a disability.
The following are not considered disabilities: transvestism, transsexualism, and gender identity disorders not resulting from physical impairments. Pedophilia, exhibitionism, and voyeurism are not included. Nor are compulsive gambling, kleptomania, and pyromania.
Resources People living with HIV/AIDS are protected by the ADA.
U.S. Department of Justice ADA Information Line
Provides general and specific ADA information, free ADA materials and information on filing a complaint. 800-514-0301 (voice) 800-514-0383 (TTY)
ADA Homepage
Has downloadable materials, technical assistance contacts, and proposed changes to the ADA. www.ada.gov
ADA Accessible Guidelines for Buildings & Facilities Provides detailed guidelines on building accessibility.
www.access-board.gov/pubs.htm
Virginia Office for Protection and Advocacy Provides technical assistance on questions regarding ADA compliance. Also provides advocacy services to people with disabilities if they are the victims of discrimination and their cases fall within VOPA’s goals and focus areas. 804-225-2042 (V/TTY) www.vopa.state.va.us Virginia Sexual & Domestic Violence Action Alliance For Sexual and Domestic Violence Agencies and additional copies of this resource. Technical Assistance Line: 866-3VSDVAA This publication is funded through an Altria Doors of Hope Grant. Adapted in part from ADA Technical Assistance CD-ROM, U.S. Department of Justice. Printed October 2005.
1010 North Thompson Street, Suite 202 • Richmond, VA 23230 Phone: 866.3.VSDVAA • Virginia Family Violence & Sexual Assault Hotline: 1.800.838.8238 (v/tty)
Barriers to Serving People with Disabilities •
People with disabilities may be abused in “non-typical” ways, such as the withholding of medications, lack of personal care, control of money, restriction of mobility, etc.
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People with disabilities may not recognize their treatment as abusive, or they may feel that they “deserve” such treatment.
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Previous history of trauma can make it difficult for people with disabilities to take necessary actions to free themselves from abusive situations.
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Isolation and lack of information makes it difficult for women with disabilities to reach out for help and for professionals to detect abuse or follow up on interventions.
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Attitudes and myths about the sexuality (or lack thereof) or promiscuity of people with disabilities place them at greater risk of assault and contribute to delays in getting help.
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People with disabilities may be physically and economically reliant on caretakers or family who are also abusive, making escape difficult.
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Hotline counselors may not have adequate knowledge of issues related to disability.
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Shelters are usually not adequately physically or communications accessible.
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Shelters are usually not able to provide residential or community support that meets the unique needs of survivors with disabilities.
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Abuse recovery models are usually not flexible enough to meet the needs of survivors who cannot leave home.
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Medical response to sexual assault has not adequately met the needs of people with disabilities.
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Courts have viewed some survivors with disabilities as “unreliable”, so that reports of abuse or sexual assault may be dismissed.
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People with disabilities may risk losing their children in a court system that may view them as incapable parents.
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People with disabilities risk forces institutionalization if they are viewed as incompetent or incapable of caring for themselves.
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Lack of community resources and support services make it difficult to help survivors with disabilities become independent and maintain their safety.
Information from Untold Stories, Unmet Needs from Jane Doe, Inc.
Tips for Assisting and Communicating with an Individual with a Brain Injury or Intellectual Disability in Non-Confrontational Situations: •
Determine if the person has had a brain injury or a cognitive disability - ask him or her, or a family member/friend. Questions may include: “Have you ever been hospitalized or treated in the Emergency Room for hitting or bumping your head? Have you ever been involved in a motor vehicle accident, fall, or other incident that may have led to a brain injury?”
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Try to obtain eye contact before you speak and say the person’s name often.
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Use simple language; repeat points; speak slowly and clearly.
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Give one direction, or ask one question at a time.
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Keep questions short and simple. Be patient and give the person time to process what’s been said and to respond.
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Repeat or re-state the question if necessary.
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Refrain from asking “yes/no” questions if possible. Rely on open-ended questions.
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Avoid abstract questions on time/sequences/reasons for behavior. Expect concrete answers.
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Have person repeat directions/instructions in their own words.
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Observe for use of a cane, walker or other assistive device and assure availability.
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Reduce distractions such as lights and especially noise level. You may not want to meet in a confined area. Persons may need to move around.
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Ask the person if he or she is on medications.
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Refocus conversation if necessary.
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Do not argue with the individual (the person may be unaware of deficits caused by the injury.)
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If necessary to touch or restrain, do not force immobile or frozen limbs to move.
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Be alert for sudden changes in behavior. Observe behavior as non-verbal communication.
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Stay calm if level of behavior escalates. Most individuals with TBI can easily be distracted and let their attention be redirected.
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Treat an adult as an adult, but be sensitive to the special needs.
Martha Lamb Justice Systems Innovations Team 05-08 adapted from Maryland Police Training Series 2001, Partners in Justice training materials 2005, and interview with DHHS/MH/DD/SAS Prevention TBI Specialist 2005 919-715-2771
Partners in Justice Resource Guide
on Intellectual (Cognitive) Disabilities for Professionals in the Criminal Justice System
“This project is supported by The Arc of North Carolina and the NC Council on Developmental Disabilities and the funds it receives through P.L.106-402, the Developmental Disabilities Assistance and Bill of Rights Act of 2000.”
Introduction On a daily basis, our criminal justice system addresses the challenge of balancing individual rights and public safety. Faced with making difficult decisions on short notice, law enforcement personnel rely on tried and tested protocols as well as their own common sense and a system of beliefs about human behavior. When people with intellectual impairments such as mental retardation or autism interact with the criminal justice system, elements of their disabilities brush against these protocols and beliefs, resulting in serious misunderstanding and sometimes tragedy. The goals of public safety and fairness can both be compromised. The North Carolina Council on Developmental Disabilities and The Arc of North Carolina recognized a need for sharing information between the criminal justice and human services systems, and, therefore, funded the Partners in Justice Project.
* On July 25, 2003, President Bush renamed the President's Committee on Mental Retardation the President's Committee for People with Intellectual Disabilities. In keeping with this decision, this document includes the term “intellectual disabilities” in the Title and Glossary.
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About The Partners in Justice Project A Project of The Arc of North Carolina
In recent years, the number of people with mental retardation and other intellectual disabilities who live in their communities has increased dramatically, and the philosophy is that the preferred living environment is almost exclusively in their own homes or with their own families. Although most people with intellectual disabilities are productive, law abiding citizens, some may become involved with the criminal justice system as offenders. Also, an alarming number of people with intellectual disabilities are victims of crime or witnesses to crimes against others. The Partners in Justice project provides information and training to: ■
Justice system professionals including judges, attorneys, magistrates and law enforcement officers on how to recognize when an individual has an intellectual disability and where to go for assistance;
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Individuals with intellectual disabilities and their families on how to avoid contact with the justice system, and what to do if they do become involved with the system as a witness, a victim, or an offender; and
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Human service workers, teachers and others on the judicial process allowing them to help people with intellectual disabilities and assure the justice system accommodates the disabilities.
Partners in Justice is developing a network of trainers across the state who can provide information and technical assistance to law enforcement agencies, attorneys, consumers and their families, and human service workers. Project staff are available free of charge
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to provide training in local communities and to provide instruction and training materials to individuals who wish to become trainers. For more information, contact: Marian Hartman -
[email protected]; or Ann Elmore -
[email protected]; or visit The Arc of North Carolina web site at www.arcnc.org.
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Traits Often Seen in People with Intellectual Disabilities May not communicate at age level: ■ Limited vocabulary; ■ Difficulty understanding/answering questions; ■ Mimics answers/responses; ■ Unable to communicate events clearly in his/her own words; and/or ■ Unable to understand complicated instructions or abstract concepts. May not understand consequences of situations: ■ Unaware of seriousness of situations; ■ Easily led or persuaded by others; and/or ■ Naïve eagerness to confess or please authority figures. May not behave appropriately: ■ Unaware of social norms and appropriate social behavior; ■ Acts younger than actual age, may display childlike behavior; ■ Displays low frustration tolerance and/or poor impulse control; and/or ■ May “act out”, become emotional, or try to leave if under pressure. May have difficulty performing tasks: ■ Inability to read or write; ■ Inability to tell time; ■ Difficulty staying focused and easily distracted; and/or ■ Awkward/poor motor coordination.
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Traits Often Seen in People with Autism Spectrum Disorder People with Autism Spectrum Disorders may: Not make eye contact: ■ Don't misinterpret limited eye contact as deceit. Have difficulty with communication: ■ May not talk (nonverbal); ■ May communicate with sign language, picture cards or gestures; ■ May have trouble understanding what YOU say; ■ May need direct, short instructions such as “Stand up now”; ■ May have a delayed response to questions; and/or ■ May not read facial expressions or body language. Invade another’s personal space unknowingly; Over-react to being touched; Have seizures; and/or Show odd behaviors such as flapping hands or pacing.
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Traits Often Seen in People with Brain Injury People who have experienced a Brain Injury may: ■
Have trouble processing or remembering information;
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Not follow instructions;
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Be perceived as belligerent or unmotivated;
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Experience headaches and fatigue;
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Become easily frustrated;
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Not perceive how behaviors affect others; relationships can become strained;
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Lose impulse control; may do or say things that are not socially appropriate (e.g. sexual acting out); and/or
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Become emotionally volatile, may have outbursts of anger, aggression, or crying.
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Tips for Communicating with a Person with an Intellectual Disability People with intellectual disabilities may need assistance to ensure that their rights are protected. These tips may be helpful: ■
■ ■ ■ ■ ■
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Speak directly to the person. Make eye contact before you speak and say her/his name often. Note: People with Autism Spectrum Disorder may find it difficult to make or maintain eye contact. This should not be interpreted as a sign of guilt. Keep sentences short. Use simple language. Speak slowly and clearly. Clearly identify yourself, explain why you are there. Ask for concrete descriptions (colors, clothing, etc.). Break complicated instructions or information into smaller parts. Use pictures or symbols of actions, if needed, to help convey meaning. Be patient and take time giving or asking for information. Ask “who,” “what,” or “where” questions. “When” or “how” questions may be more difficult to answer. Avoid confusing questions about time, sequences, or reasons for behavior. Repeat questions more than once if necessary. If the person does not seem to understand, ask it in a different way. Do not ask leading questions or questions phrased in a way to solicit a certain answer. Phrase questions open-ended when possible (e.g. “Tell me what happened.”) Treat adults as adults, regardless of their disabilities. If you are unsure if the person really understands what you are saying, ask the person to repeat it in his/her own words. Be sensitive to self-blame and fear. Pay attention to non-verbal cues, over compliance, resistance and body language.
Myths about Mental Retardation Myth 1: Mental retardation is the same as mental “illness.” The fact is: Mental retardation is a developmental disability characterized by below average intellectual functioning. With the appropriate intervention and education, a person with mental retardation can lead a satisfying and productive life in the community. Myth 2: Mental retardation is a contagious disease. The fact is: Mental retardation is not a disease and it is certainly not contagious. It is a condition that affects an individual because of some change or damage with the developing brain and neurological system. Mental retardation is a lifelong condition. There is no “cure”. Myth 3: People with severe and profound mental retardation should be locked away in institutions for their own and society’s safety. The fact is: Research shows that most people with severe and profound mental retardation can learn to at least care for their basic needs. Many can perform useful work with support and can otherwise adapt to normal patterns of life. It has been proven that the most effective environment for everyone to learn and develop is in the community and offers a family-like atmosphere of care and nurturing. Myth 4: Educational and vocational training will not help people with mental retardation. The fact is: Most persons with mental retardation can learn, although at a slower rate, and are capable of living in the community with little or no support services.
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Early intervention is critical since it is proven that the earlier the disability is identified and services are provided, the greater the probability the individual will enjoy a productive and meaningful life in the community. Vocational programs help prepare individuals for work. Supported employment helps people find jobs in the competitive work environment. Myth 5: We do not know what causes mental retardation and it cannot be prevented. The fact is: Mental retardation can be caused by any condition which impairs development of the brain before or during birth or in early childhood. More than 250 causes have been discovered, but they account for only about one-fourth of the causes of mental retardation. The most well-known are: Rubella or German measles in the pregnant female, meningitis, toxoplasmosis, Rh factor, and chromosomal abnormalities such as Down Syndrome. Mental retardation can be prevented in some cases. Some prevention strategies include: ■ Access to good prenatal and postnatal care for mother and child. ■ Improved nutrition in pregnant women and infants. ■ Avoiding the use of drugs and alcohol during pregnancy. ■ Newborn screening to detect disorders such as hypothyroidism and PKU. ■ Routine screening and immunizations of mothers to prevent Rh blood factor. ■ Use of child seats and seat belts to prevent head injuries. ■ Screening for lead poisoning for all children under the age of 5.
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Dual Diagnosis or Co-Occurring Disorders When an Intellectual Disability is Complicated by Mental Illness Good mental health is an essential ingredient in quality of life and is a goal for all people, including those with intellectual disabilities. Mental illness is a disease resulting in severe disturbances of behavior, mood, thought processes, cognition, and/or social and interpersonal relationships. Mental illness may occur at any time of life, may be temporary or episodic, and may respond to treatment. The presence of mental illness in individuals with normal intellectual abilities is difficult at best. In individuals with intellectual disabilities, it is devastating without appropriate interventions. An intellectual disability caused by mental retardation results in abnormal thought processes – not abnormal thoughts – and is a permanent condition. A person with an intellectual disability caused by mental retardation will have below average intellectual functioning, slow thought processes, and difficulty learning. Dual diagnosis is the term applied when an individual experiences more than one disorder. Most commonly, dual diagnoses are described by mental health professionals as mental illness with a cooccurring substance abuse issue. The impact of an intellectual disability co-occurring with mental illness is described below. Individuals who are diagnosed with an intellectual disability and mental illness have more difficulty adjusting to life in the community. In this time when emphasis is on community living and providing services in the least restrictive environment, experts
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predict that even this most difficult group can be assisted by positive behavior support directed by mental health professionals and medication treatment programs prescribed by a physician. Individuals with both intellectual disabilities and mental illness are best served by providers specially trained to work with these individuals. People with dual diagnoses are limited not only by intellectual ability but by the behavior generated by the mental illness. The presence of mental illness often disrupts habilitation efforts. When mental illness occurs in a person with an intellectual disability, behavior management alone will not be as effective as combining treatment for both disabilities. How many people with intellectual disabilities are mentally ill? The rate of mental illness among individuals with intellectual disabilities varies considerably depending on age, type of mental illness and statistical analysis. Rates of 10 to 40 percent have been reported for individuals served by community agencies. Some researchers report that the rate of psychiatric disability in people with mental retardation may be four to five times greater than in the general population. Statistics for people with all intellectual disabilities are not available. Conduct and behavioral problems occur for about one in five people with intellectual disabilities living in the community. Why do people with mental retardation develop mental illnesses and behavior problems? Scientists still do not know for certain what causes mental illness. Most researchers believe that both biological and psychological risk factors are involved to varying degrees depending on the specific disorder. Some disorders may be wholly or largely caused by biochemical and structural abnormalities in the brain and some people may possibly have a genetic predisposition. Biochemical and structural abnormalities seem to be especially important in the occurrence of psychosis and explosive behavior. Life history,
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environment and individual stressors also may contribute to the severity of psychosis and may precipitate increases in symptoms and behaviors in susceptible individuals. People with dual diagnoses are not successfully treated in psychiatric facilities because of their intellectual disabilities; nor are they successful in a facility designed to habilitate people with intellectual disabilities because of the mental illness and need for psychotropic medications. Programs designed for people with intellectual disabilities typically do not have appropriate staff to address the needs of people with mental illness. There is a great risk to other program participants if a person with mental illness is included in a program where the staff are not trained to treat a person with mental illness. Many cases of abnormal behavior are caused by the intellectual disability itself as the individual lacks the ability to keep behaviors within a socially acceptable norm. Those without that mental ability to control behavior need positive behavior support. When mental illness is acerbated by a neurochemical imbalance, psychotropic medication may be helpful. What types of treatment are available? Extraordinary progress has been made in the last 20 years with regard to outcomes and treatment of mental illnesses in the general population. However, these advances are difficult to adapt for use with people with intellectual disabilities. Families continue to have great difficulty locating appropriate services. Psychopharmacology. Many disorders can be controlled or alleviated with psychotropic medication; however, there has been a tendency to over-medicate people with intellectual disabilities. Careful monitoring of the side effects of medications is critical and often environmental adaptations can effectively mitigate behaviors. Even when used appropriately, medications are only part of an array of treatments that may promote wellness.
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Counseling/Psychotherapy. People with mild intellectual disabilities may benefit from counseling. Many individuals cope better when another person listens to their problems and provides social support and understanding. However, mental health professionals with experience counseling people with intellectual disabilities are few, and the process is long and repetitive. Intellectual Behavior Therapy. This treatment teaches people with mild intellectual disabilities to recognize situations that get them into trouble and to develop alternative behaviors and solutions to their problems. Although widely used with the general population, intellectual behavior therapy has been adapted only recently for use with people with intellectual disabilities. Positive Behavior Support. This approach is widely used with people with mental retardation. In positive behavior support, the focus is on relationship and instruction rather than consequence and punishment. The approach often leads to significant behavioral improvements, at least during the time the treatment is in effect. Social Skills Training. Individuals are gradually taught effective social interactions and appropriate social behavior. This should be part of a daily living process rather than a discrete process. What types of services are available for the individual who has both intellectual disabilities and mental illness? Historically, people with dual diagnoses were shuttled between service systems and, in the process, underserved. Today, the needs of individuals with dual diagnoses are still overshadowed by the primary diagnosis of an intellectual disability.
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Without agencies identified to deal specifically with this population, persons with dual diagnoses are often passed from agency to agency, from institution to institution, from group home to group home, as different therapies and treatments are tried. The resulting frustration only leads to a deepening of the problem. The national trend toward deinstitutionalization from both psychiatric hospitals and mental retardation centers has significantly complicated the issue, as there are few service providers qualified to address both the intellectual disability and the mental illness. Availability of qualified providers is further hindered by legal considerations such as licensing and liability. Thus, many individuals with dual diagnoses end up in the legal system as their behaviors deteriorate, and social stigma influences the way in which they are viewed by society. Ideally, an individual with dual diagnoses will find a provider who employs a team approach and has staff who are cross-trained in both disabilities to provide treatment, supports and services. An interdisciplinary team may consist of program specialists, clinical social workers, nurses and medical doctors, dietitians, paraprofessionals, and residential care staff. Participating in the life of the community with skill building activities like work, leisure activities, developing a network of friends and families for support, and adjunctive therapies are components that enhance community inclusion, reduce stigma and promote well-being and optimum health. Since individuals with dual diagnoses are intimately involved with their caregivers, the caregivers can provide valuable information regarding changes in the individuals’ functioning. Because behavior is a form of communication, even individuals who are nonverbal may express themselves in ways that assist in achieving personal outcomes.
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Presently, treatment sites and community-based programs exist in some places, but are not universally available throughout the United States. Finding appropriate services may require persistence. For information on dual diagnosis services, contact the local chapter of The Arc; a nearby University Affiliated Program in Mental Retardation and Developmental Disabilities; or the NC Division of Mental Health, Developmental Disabilities and Substance Abuse Services. The National Association for People with a Dual Diagnosis (800-331-5362) may be able to recommend a local psychiatrist or psychologist.
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Guardianship Full guardianship is a severe limitation of a person's civil rights and can be a significant barrier to the ideal of self-determination for people with disabilities. North Carolina law and practices are geared to a routine and automatic finding that a person is incompetent and needs a full guardian. There is little consideration of less restrictive alternatives and no requirement that the actual functioning capacity of the person for whom guardianship is sought be evaluated before full guardianship is ordered. Families and service providers are often unaware of any alternatives. Within existing North Carolina law however, there are options that can be used to make guardianship procedures more sensitive to individual diversity and choice and create limited guardianships that are more tailored to the strengths and needs of the person for whom guardianship is sought. Limited guardianship is the tool to make this happen, but within our court system, it has not been a user-friendly option. With a grant from the North Carolina Council on Developmental Disabilities, Carolina Legal Assistance has established five pilot sites where the Clerk of Superior Court is working with lawyers, human service agencies and advocates to test new forms that make limited guardianship a practical reality for people with disabilities. The forms include a Guardianship Capacity Questionnaire to help families, court officials and agencies determine if a person needs a guardian at all, and if so, how a limited guardianship order can be drafted to address the life domains where the person needs help without infringing on those life domains where they can remain independent.
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Benefits - Just the Basics Citizens of North Carolina have a number of financial assistance programs available to them if they are disabled or poor. Many people with intellectual disabilities will qualify for benefit programs. Each program has its own set of eligibility requirements. This is an overview of benefits programs available to help people with disabilities afford medical treatment and some of the costs of daily living in the community. Federal programs include: Social Security Disability Insurance (SSDI) provides benefits to individuals who are disabled or blind and who are insured by workers’ contributions to the Social Security trust fund. These contributions are the Federal Insurance Contributions Act (FICA) social security tax paid on their earnings or those of their spouses or parents. Social Security Disability Insurance pays benefits to people who cannot work because they have a medical condition that is expected to last at least one year or result in death. Federal law requires this very strict definition of disability. While some programs give money to people with partial disability or short-term disability, Social Security does not. Certain family members of workers with disabilities also can receive money from Social Security. Supplemental Security Income (SSI) is administered by the Social Security Administration for people who are aged, blind or disabled, including children under age 18 who have limited income or resources to guarantee a certain level of income. SSI recipients have contributed nothing or not enough to the Social Security System to be eligible for benefits on their own earnings record. An application for SSI is also an application for Medicaid. Individuals who are eligible for SSI automatically qualify
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for Medicaid. Eligibility for Medicaid begins with the first day of the month in which eligibility for SSI begins and continues as long as the individual remains eligible for SSI. To be eligible for disability, an individual must meet the federal definition of disability. For purposes of Medicaid and SSI, that definition is “a physical or mental impairment which prevents an individual from engaging in any substantial gainful activity (or for a child under 18, an impairment of comparable severity) and which has lasted or is expected to last for at least 12 months or is expected to result in death.” Medicaid is health insurance that helps many people who can not afford medical care to pay for some or all of their medical bills. Medicaid is available only to certain lowincome individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid sends payments directly to the health care providers. Some co-pay may be required. Through the NC Department of Health and Human Services, eligible individuals may receive funding through the following sources: The Community Alternatives Program for Persons with Mental Retardation/Developmental Disabilities (CAPMR/DD) is a special Medicaid program serving individuals who would otherwise require care in an intermediate care facility for people with the mental retardation/developmental disabilities (ICF/MR). It allows these individuals the opportunity to receive services in the community instead of residing in an institutional or group home setting. The Community Alternatives Program for Disabled Adults (CAP-DA) provides a package of services to allow adults (age 18 and older) who qualify for nursing facility care to remain in their private residences. The program is available in all North Carolina counties.
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Intermediate Care Facility/Mental Retardation (ICF/MR) provides funding for people with mental retardation who live in congregate settings such as the stateoperated mental retardation centers and large private residential facilities for people with mental retardation. Skilled Nursing Facility (SNF) is a long-term care facility which provides twenty-four hour skilled nursing care with a RN or LPN on duty at all times. Funding to support placement in a SNF may come from private or public (Medicaid) sources. Special Assistance (SA) is an additional funding source for individuals who are disabled. It augments state and federal support and pays cash benefits to eligible recipients who reside in licensed facilities authorized to receive SA payments. To be eligible for SA, an individual must be eligible for SSI, or ineligible for SSI solely due to income. It is 50% State and 50% county funded and is paid in the following categories: a. Adult Care Home—Cash payments and medical assistance for eligible individuals who are aged, disabled or blind residing in a licensed adult care home facility. b. Certain Disabled—Cash payment only for individuals in a private living arrangement who meet the state's definition of disability. (This program is not available in all counties.) c. In-home—Cash payments and medical assistance for eligible individuals who are aged, disabled or blind residing in a private living arrangement, and who are at risk of placement in an adult care home. To learn more about benefits, contact the county Department of Social Services.
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Choosing Words the “People-first” Way In choosing words about people with disabilities, the guiding principle is to refer to the person first, not the disability. Instead of saying “the disabled,” it is preferable to say “people with disabilities.” Putting the word “people” first places emphasis on the person instead of the disability. The disability is no longer the primary, defining characteristic of an individual but merely one aspect of the whole person. It is still all too common in our society to come across labels for disabilities that either have negative connotations or are misleading. For this reason, some words should be completely avoided, such as: afflicted, bleeder, crazy, defective, deformed, invalid, lame, maimed, pitiful, retard, spastic, unfortunate. All of these words devalue the person they attempt to describe. Avoid them when speaking to or about persons with disabilities. Here are some suggestions on how to incorporate people-first language into your written and verbal communications. AVOID: “afflicted with” a particular condition, such as polio or multiple sclerosis USE: “someone who had polio” or “person with multiple sclerosis” AVOID: crippled, confined to a wheelchair, wheelchair bound, wheelchair user USE: person with a physical disability, person who uses a wheelchair
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AVOID: deaf and dumb, deaf mute USE: person who does not hear or hear well, person who does not speak, person who uses an alternative communication device. Note: Many people who are deaf, advocate for the term “deaf person” to symbolize the pride they feel as part of the deaf community. AVOID: epileptic USE: person with epilepsy, person with a seizure disorder AVOID: cerebral palsied, spastic USE: person with cerebral palsy AVOID: stricken with..., a victim of ..., suffering from ... USE: person with ... AVOID: mongoloid USE: person with Down syndrome AVOID: handicapped person, the handicapped, handicapped USE: person with a disability, people with disabilities AVOID: physically challenged, intellectually challenged, retarded USE: person with a disability, people with intellectual disabilities AVOID: brain injured person, brain dead, “not right”, “off a little”, “not cooking on all burners” USE: survivor of a brain injury, person with a brain injury, person who has sustained a brain injury
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Glossary Accessible: Buildings, structures, programs, transportation services, public services, etc. that are designed or modified to enable people with disabilities to use them without undue difficulty and that conform to Americans with Disabilities Act (ADA) requirements. Examples include ramps for entering and exiting buildings, TTY relay services for telephone use, lifts on public transportation, and documents in Braille, large print, CD, etc. Accommodation: The removal of barriers or making special arrangements that allow full participation of persons with disabilities in all activities in keeping with the provisions of Section 504 of the Rehabilitation Act and the Americans with Disabilities Act. Americans with Disabilities Act of 1990 (P.L. 101-336): Guarantees equal opportunity for individuals with disabilities in employment, public accommodation, transportation, state and local government services and telecommunications. Attention Deficit Disorder (ADD): A diagnosis with symptoms that may include difficulty paying attention, being easily distracted and the inability to focus more than a few moments on mental tasks. (See attention deficit hyperactivity disorder.) Most people with ADD alone are not eligible for developmental disabilities services. Attention Deficit Hyperactivity Disorder (ADHD): A diagnosis with symptoms that may include difficulty focusing attention and effort to tasks, difficulty in impulse control or delay of gratification and increased activity unrelated to the current task or situation. Autism Spectrum Disorder (ASD): Disorders of communication and behavior. ASDs are brain dysfunctions that affect a person's ability to understand what he/she sees, hears, and otherwise senses. Benefits (Financial): Any of a number of financial public assistance programs from federal, state or local sources that may be available to provide funding for eligible applicants who have
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intellectual disabilities. Some types of benefits are Supplemental Security Income, Social Security Disability Insurance, Medicaid, Community Alternatives Programs/ Mental Retardation, Community Alternatives Program/Disabled Adult, Specialized Nursing Facility, Intermediate Care Facility/ Mental Retardation, Special Assistance. See Benefits Section, page 17. Brain Injury: Any level of injury to the brain often caused by an impact with the skull. Acquired Brain Injury (ABI): A brain injury that occurs after birth. It can be a result of an internal injury (e.g., tumor, stroke, aneurysm), an external injury (e.g., motor vehicle accident, fall, sports injury) or ingestion of a toxic substance. Traumatic Brain Injury (TBI) is a form of ABI. Congenital Brain Injury (CBI): A brain injury that is present at birth and may be due to genetic or environmental occurrences. Traumatic Brain Injury (TBI): A brain injury from externally inflicted trauma such as incidents involving motor vehicles, falls, acts of violence and sports injuries. TBI can range from mild (concussions) to severe, with outcomes ranging from a few symptoms to lifelong impairment. Cognitive Disability: See Intellectual Disability. Consumers: People with disabilities or parents/guardians of people with disabilities who may use or need services or supports. Other commonly used terms are “participants” and “clients.” See Self-Advocates. Developmental Disability (DD): North Carolina General Statute 122C-3(12a) defines a developmental disability as a severe, chronic disability of a person which is attributable to mental or physical impairment or combination of mental and physical impairments; is manifested before the person attains age 22, unless the disability is caused by traumatic head injury and is manifested after age 22; is likely to continue indefinitely; results in substantial functional
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limitations in three or more of the following areas of major life activity: (a) self-care, (b) reception (understanding) and expressive language, (c) learning, (d) mobility (ability to move), (e) selfdirection (motivation), (f) the capacity for independent living, (g) economic self-sufficiency; reflects the person’s need for a combination or sequence of special interdisciplinary services which are of a lifelong or extended duration and are individually planned and coordinated; or when applied to children from birth through four years of age, may be evidenced as developmental delay. Down Syndrome: A genetic condition caused by a chromosomal abnormality resulting in some degree of intellectual disability and other developmental delays. Common physical features of Down syndrome include small stature, decreased muscle tone, flattened bridge of the nose and upward slant to the eyes. Epilepsy: A physical condition that occurs when there is a sudden, abnormal electrical activity in the brain causing a person’s consciousness, movement or actions to be altered for a short time. Epilepsy is also called a seizure disorder. Group Home: A home that is licensed to provide 24-hour residential supports for people who have disabilities in exchange for compensation from state or private funds. Group homes differ in the numbers of people served and in the level of support provided to the persons receiving services. State law dictates how services will be provided and methods of accountability for service provision. Guardian: A person or organization appointed by the court for the purpose of performing duties related to the care, custody, or control of an individual and which may include, but is not limited to, consenting for medical/surgical or treatment procedures and handling of business and legal affairs. In the case of a minor, it is a parent or someone standing in “loco parentis.” See Guardianship Section, page 16. Handicap: An outdated term referring to physical and social barriers that put people with disabilities at a disadvantage and hinder their ability to fully participate in the community. A person with a disability is not “handicapped” but may be limited by attitudinal, physical and other barriers that society fails to remove.
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Independent Living: Independent living refers to achieving the ability to live in the home of one’s choice in the community with some level of support that may or may not be reduced over time. It refers to learning skills that enable one to participate in activities of choice in one’s community, to manage one’s affairs, to have relationships and may include maintaining employment. It also refers to a program operated by Vocational Rehabilitation Services that provides funds to enable people with disabilities to live in their communities. Independent Living Program: Assists individuals with significant disabilities in achieving independence by providing services that enable them to live and function in the homes and communities of their choice. Vocational Rehabilitation Counselors and program participants jointly develop a plan to provide a viable, cost-effective alternative to institutional living; may help maintain or improve employment opportunities; and may include independent living skills training, home and vehicle modification, peer counseling and advocacy, adaptive aids, prosthetics, consumer-managed personal assistance services, and recreational therapy. Intellectual Disability: The presence of a sub-average general intellectual functioning associated with or resulting in impairments in adaptive behavior, including mental retardation, acquired brain injuries (stroke), traumatic brain injuries, Autism, and Alzheimers Disease. Intellectual disabilities are chemical or physical alterations within the brain that result in different thought processes. Learning Disability (LD): A lifelong disorder that affects a person’s ability to either interpret what he/she sees and hears or to link information from different parts of the brain. These limitations can appear in many ways—as specific difficulties with spoken and written language, coordination, self-control or attention. A person with a learning disability may have normal intelligence; however, there is a significant discrepancy in intelligence level and ability to learn and perform certain tasks.
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Mental Retardation: Mental retardation is characterized by significant limitations in both intellectual functioning and social and practical adaptive skills. This disability originates before age 22. Personal Assistant: A Personal Assistant is someone who assists a person with a disability in activities of daily living such as: bathing, dressing, mobility, transferring in and out of bed or wheelchair, toileting, eating, cooking, cleaning house, on-the-job personal support, handling money and planning daily activities. Seizure: Sudden, uncontrollable spasm of muscles caused by excessive electrical activity in the brain. See Epilepsy. Self-Advocate: An individual who speaks or acts for him/herself. This includes making choices and decisions about one’s life. See Consumer. Self-Determination: The right of people with disabilities to make choices about their own lives, to have the same rights and responsibilities as everyone else, and to speak and advocate for themselves. Speech Impairment: Any of several speech problems that include articulation impairment (omissions, substitutions or distortions of sound), voice impairment (inappropriate pitch, loudness or voice quality) and fluency impairment (abnormal rate of speaking, speech interruptions and repetition of sounds, words, phrases or sentences) which interfere with effective communication. Tourette Syndrome: An inherited neurological disorder characterized by sudden, involuntary, repetitive muscle movements and uncontrollable vocal sounds called tics which can include inappropriate words and phrases. A person with TS may touch other people excessively or repeat actions obsessively and unnecessarily. Vocational Rehabilitation: An agency that provides counseling, training, education, medical, transportation, and other support services to persons with physical or mental disabilities in order to help them become independent or job-ready.
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North Carolina Organizations: Grassroots, Advocacy, and Professional Organizations Alzheimer’s Association– is a nationwide network of chapters that offer frontline support to individuals affected by Alzheimer’s with services that include 24/7 information and referral, safety services, and education and support groups. The Association has a 24-hour toll-free helpline- 800-888-6671 and website: www.Alz-NC.org Western Carolina Chapter 3800 Shamrock Drive Charlotte, NC 28215-3220 704-532-7392 (phone) 704-532-5421 (fax) Mountain Region Office 31 College Place, Suite D320 Asheville, NC 28801-2644 828-254-7363 (phone) 828-255-0948 (fax) Triad Area Office 1315 Ashleybrook Lane Winston-Salem, NC 27103 336-725-3085 (phone) 336-725-3081 (fax) Foothills Area Office 260 First Avenue, NW Suite 218 Hickory, NC 28601-6161 828-267-7100 (phone) 828-267-0088 (fax)
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Eastern North Carolina Chapter 400 Oberlin Road, Suite 220 Raleigh, NC 27605-1351 919-832-3732 (phone) 919-832-7989 (fax) Wilmington Regional Office 714 Champ Davis Road Wilmington, NC 28411 910-686-1944 (phone) 910-686-1945 (fax) The Arc of North Carolina, Inc.– is a statewide advocacy organization committed to securing for all people with mental retardation and other developmental disabilities the opportunity to choose and realize their goals of where and how they learn, live, work, and play. Local chapters exist in some communities. Call The Arc for further information. The Arc of North Carolina (Headquarters) 4200 Six Forks Road, Suite 100 Raleigh, NC 27609 919-782-4632 (phone) 800-662-8706 (toll-free) 919-782-4634 (fax) www.arcnc.org Association of Self-Advocates of North Carolina– is a statewide advocacy organization made up of self-advocates and professionals interested in supporting self-advocacy for people with developmental disabilities. P.O. Box 17271 Raleigh, NC 27609 3801 Lake Boone Trail, Suite 260 Raleigh, NC 27607 919-420-7995 (phone) 919-420-7917 (fax)
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Attention Deficit Disorder Association– is a national organization that provides information, resources and networking to adults with AD/HD and to the professionals working with them. To identify an ADD group in your area, contact: Attention Deficit Disorder Association (ADDA) P.O. Box 543 Pottstown, PA 19464 484-945-2101 (phone) www.add.org Autism Society of North Carolina, Inc.– is an organization committed to providing support and promoting opportunities which enhance the lives of individuals within the autism spectrum and their families. 505 Oberlin Road, Suite 230 Raleigh, NC 27605-1345 919-743-0204 (phone) 800-442-2762 (toll-free, in NC) 919-743-0208 (fax) www.autismsociety-nc.org Brain Injury Association of NC, Inc.– is an affiliate of the Brain Injury Association of America. The Association has Family and Community Support Centers in Raleigh, Greenville, and Charlotte and 29 local chapters and support groups across the state. Triangle Center P.O. Box 748 Raleigh, NC 27601 919-833-9634 (phone) 800-377-1464 (toll-free helpline) www.bianc.net Central Piedmont Center at the Charlotte Institute of Rehabilitation 1100 Blythe Boulevard Charlotte, NC 28203 704-355-1502 (phone)
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Eastern Family and Community Support Center 202 East Arlington Boulevard, Suite T Greenville, NC 27858 252-439-1900 (phone) Carolina Legal Assistance– is a private, non-profit corporation that offers legal representation to children and adults with mental illness and developmental disabilities. P.O. Box 2446 Raleigh, NC 27602-2466 919-856-2195 (phone) 919-856-2244 (fax) www.cladisabilitylaw.org Coalition for Persons Disabled by Mental Illness (CPDMI)– is composed of state-wide, non-profit advocacy, consumer, family and provider organizations who advocate for adequate, quality public services for citizens of North Carolina with mental illness. 1004 Dresser Court, Suite 106 Raleigh, NC 27609 919-872-1005 (phone) www.cpdmi.org Epilepsy Information Service– responds to requests for information about epilepsy, the latest treatment options, and local support groups. Medical Center Blvd. Winston-Salem, NC 27157-1078 336-716-2319 (phone) 800-642-0500 (toll-free) www.bgsm.edu/neuro/epilepsy/information.htm The Exceptional Children's Assistance Center– is a Parent Training & Information Center committed to improving the lives of all children through a special emphasis on children with disabilities. Services are provided at no charge to parents and families.
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907 Barra Row, Suites 102/103 Davidson, NC 28036 704-892-1321 (phone/voice/TTD) 704-892-5028 (fax) 800-962-6817 (Parent Information Line) www.ecac-parentcenter.org Governor's Institute on Alcohol & Substance Abuse, Inc.– is a private nonprofit organization that assists health professionals in addressing the health problems of substance use, misuse, abuse, and dependency in North Carolinians. Its mission is to promote the health and well-being of all North Carolina citizens by fostering improved education, research, and communication among health care professionals regarding the impact of, response to, and prevention of alcohol and other drug use. Governor's Institute on Alcohol & Substance Abuse, Inc. Park Offices 200 - Suite 200 P.O. Box 13374 Research Triangle Park, NC 27709-3374 919-990-9559 (phone) 919-990-9518 (fax) http://www.governorsinstitute.org Mental Health Association in NC, Inc.– is the state's largest private, non-profit mental health organization addressing advocacy, education and service. It promotes mental health and works to eliminate discrimination against people with mental disorders. 3820 Bland Road Raleigh, NC 27609 919-981-0740 (phone) 888-881-0740 (toll-free) 919-954-7238 (fax) www.mha-nc.org
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NAMI North Carolina– seeks to improve the quality of life for individuals and their families living with the debilitating effects of severe and persistent mental illness, and to protect the dignity of people living with brain disorders through advocacy, education, and support. NAMI focuses specifically upon those mental illnesses that are brain disorders. These are serious illnesses that can affect a person's ability to think, feel and relate to other people and the environment. NAMI North Carolina 309 Millbrook Road, Ste 121 Raleigh, NC 27609 919-788-0801 (phone) 919-788-0906 (fax) http://www.naminc North Carolina Guardianship Association– was founded in 1997 to train and support individuals who are court-appointed guardians for persons who lack the capacity to make sound personal and business decisions and who have no family members or friends to serve in that capacity. NCGA PO Box 17673 Raleigh, NC 27619 919-266-9204 (phone) 919-266-9207 (fax) http://www.nc-guardian.org North Carolina Stroke Association– is a chapter of the National Stroke Association. It offers regional resource connections and health care professional volunteer hospital visitation programs. 407 South Hawthorne Road P.O. Box 571002 Winston-Salem, NC 27157-1002 336-713-5052 (phone-main) 336-713-5053 (phone- Stroke Support & Education) 336-713-5051 (fax) www.ncstroke.org
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NC Mental Health Consumers Organization– is not affiliated with NAMI NC. It has provided advocacy and support to adults with mental illness since 1989. PO Box 27042 Raleigh, NC 27611 919-832-2285 (phone) 919-828-6999 (fax) 800-326-3842 (toll-free)
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North Carolina Departments and Agencies Department of Juvenile Justice & Delinquency Prevention– is the home of North Carolina’s comprehensive juvenile justice system. 410 South Salisbury Street Raleigh, NC 27601 1801 Mail Service Center Raleigh, NC 27699-1801 919-733-3388 (phone) www.juvjus.state.nc.us Governor's Advocacy Council for Persons with Disabilities– is part of a nationwide system of protection and advocacy agencies committed to protecting civil rights and serving citizens with disabilities in North Carolina. 2113 Cameron Street, Suite 218 1314 Mail Service Center Raleigh, NC 27699-1344 919-733-9250 (phone) 800-821-6922 (voice) 888-268-5535 (TDD) 919-733-9173 (fax) www.gacpd.com NC Council on Developmental Disabilities– part of a national network of organizations that assist people with developmental disabilities and their families; working to promote the “independence, productivity, integration and inclusion into the community.” 3801 Lake Boone Trail, Suite 250 Raleigh, NC 27607 919-420-7901 (phone) 800-357-6916 (voice, TDD) 919-420-7917 (fax) www.nc-ddc.org
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North Carolina Department of Health and Human Services Division of Aging and Adult Services– promotes independence and enhances the dignity of older and disabled persons and their families through a community-based system of opportunities, services, benefits, and protections; readies younger generations to enjoy their later years; and helps society and government plan and prepare for the changing demographics. Working with Area Agencies on Aging and more than 450 public and private local organizations, the Division of Aging supports a wide range of home and community-based services and works to ensure the rights and protections of older people for their social, health, and economic well-being. Division of Aging and Adult Services 2101 Mail Service Center Raleigh, NC 27699-2101 919-733-3983 (phone) 919-733-0443 (fax) www.dhhs.state.nc.us/aging CareLine– guides citizens through the human service system by providing information and referral and assists with problem resolution for concerns or complaints. 2012 Mail Service Center Raleigh, NC 27699-2012 919-733-4261 (phone) 800-662-7030 (Voice/Spanish) 877-452-2514 (toll-free) 919-733-4851 (TTY dedicated) 919-715-8174 (fax) www.dhhs.state.nc.us/ocs
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Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS)– provides people with or at risk for mental illness, developmental disabilities and substance abuse problems and their families the necessary prevention, intervention, treatment, services and supports they need to live successfully in communities of their choice. MH/DD/SAS 325 N. Salisbury Street 3001 Mail Service Center Raleigh, NC 27699-3001 919-733-7011 (phone) www.dhhs.state.nc.us/mhddsas Division of Social Services– assists and provides opportunities for individuals and families in need of basic economic support and services to become self-supporting and self-reliant. DSS 325 N. Salisbury Street 2401 Mail Service Center Raleigh, NC 27699-2401 www.dhhs.state.nc.us/dss Division of Vocational Rehabilitation Services– provides counseling, training, education, medical, transportation, and other support services to persons with physical or mental disabilities in order to help them become independent or job-ready. Vocational rehabilitation counselors work with business and community agencies to help them prepare their worksites to accommodate employees who have physical or mental disabilities. Vocational Rehabilitation Services 2801 Mail Service Center Raleigh, NC 27699-2801 919-855-3500 (phone) 919-733-7968 (fax) www.dvr.dhhs.state.nc.us
36
Notes
37
Notes
38
Partners in Justice 1-800-662-8706
Disability and Domestic Violence and Sexual Assault • • •
Be Healthy
•
Violence and Sexual Assault
Domestic Violence and Sexual Assault Another important public health issue for women with disabilities is domestic violence and sexual assault. Women with disabilities may be at a higher risk for violence than the general public. They are 5 times more likely to be sexually assaulted than women without disabilities (NC BRFSS 2001). Nationally, about 85% of women with disabilities have experienced domestic violence (Feuerstein, 1997). At least 76% of adults with cognitive disabilities have been sexually assaulted (National Center for Injury Prevention and Control, 1996). In addition, services may not be accessible and inclusive for these women. The NCODH recognizes the need for women with disabilities to have the same access to domestic violence and sexual assault services as all women and is currently working to increase the capacity of programs in NC to serve women with disabilities who are survivors of violence. Access for All: Developing Systems Change NCODH received a two-year grant from the Carolina Governor's Crime Commission in 2005 to develop fundamental elements of accessibility for the state’s domestic violence and sexual assault agencies regarding their hotline, shelter, counseling and advocacy services through a systems change approach. By incorporating the fundamental elements into their core services, NC domestic violence and sexual assault programs will have increased capacity to serve women with disabilities through improved accessibility of agency, materials, communication, and buildings.
NCODH Publications Domestic Violence and Sexual Assault Brochures These brochures, developed by NCODH, the NC Coalition Against Sexual Assault, and NC Coalition Against Domestic Violence, are designed for domestic violence and sexual assault service providers across the state to learn more about disability and violence. The brochures describe how people with disabilities are vulnerable to violence; types of abuse people with disabilities may experience with the sexual or domestic violence; and strategies for agencies to improve access to and delivery of services. To order brochures, contact the NC Coalition Against Sexual Assault at 1-888-727-2272 and/or the NC Coalition Against Domestic Violence at 1-888232-9124. Violence and People with Disabilities brochure (111KB) Violence and People with Disabilities brochure (448KB)
Basic Disability Awareness: Providing Disability-Friendly Sexual and Domestic Violence Services This training manual is in development for sexual assault and domestic violence service providers. Goals for training participants include gaining knowledge about how to provide accessible programs, communication, and buildings to all people and how to create a service environment where people with disabilities feel welcome and accepted. for All Executive Summary (62KB) This summary describes a 2003-2005 grant project, Access for All, funded by the NC Governor’s Crime Commission to assist domestic violence and sexual assault agencies in six NC counties to improve accessibility of their services for women with disabilities. The report describes project activities and evaluation and next steps to improving access to domestic violence and sexual assault services throughout the state.
Other Resources
Publications Stop the Violence, Break the Silence A training guide for domestic violence and sexual assault service providers. SafePlace, PO Box 19454, Austin, TX 78760, (512) 267-SAFE (7233) or 512-927-9616 TTY, ://www.austinsafeplace.org Balancing the Power: Creating a Crisis Center Accessible to People with Disabilities A guide to providing accessible services for domestic violence and sexual assault programs. SafePlace, PO Box 19454, Austin, TX 78760, (512) 267-SAFE (7233) or 512-927-9616 TTY, ://www.austin-safeplace.org/ Program and Service Accessibility: A Guide for Serving Victims with Disabilities A manual about providing accessible services for people with disabilities. Leslie A. Meyers, Center for Research on Women with Disabilities, Independence First, 600 W. Virginia St., Suite 301, (414) 291-7529, ://www.independencefirst.org/ Serving Women with Disabilities: A Guide for Domestic Abuse Programs. Guidelines for providing accessible domestic violence services. Leslie A. Myers, Center for Research on Women with Disabilities, Independence First, 600 W. Virginia St. Suite 301, (414) 291-7520, ://www.independencefirst.org/
Untold Stories, Unmet Needs. Understanding the Needs of Sexual Assault and Domestic Violence Survivors with Physical and Sensory Disabilities. A training manual about serving clients with physical, visual or hearing disabilities. Jane Doe, Inc., 14 Beacon Street, Suite 507, Boston, MA 02108, (617) 248-0922, .JaneDoe.org
Videos Disability, Violence, and Survival: A Personal Story (11 minutes) SafePlace, (512) 267-SAFE (7233), (512)927-9616 TTY, ://www.austin-safeplace.org/ Serving Women with Disabilities An Advocate’s Guide (33 minutes) New Mexico Attorney General's Office, ://www.ago.state.nm.us End the Silence (8 minutes) The Institute on Disabilities at Temple University (Pennsylvania's University Center for Excellence on Developmental Disabilities), (215) 204-1356 (voice/TTY), ://disabilities.temple.edu
Organizations SafePlace PO Box 19454, Austin, TX 78760, (512)-267-SAFE (7233) or (512) 927-9616 (TTY), ://www.austin-safeplace.org/ Center for Research on Women with Disabilities (CROWD) 3440 Richmond Avenue, Suite B - Houston, Texas 77046, (713) 960-0505 or (800) 44-CROWD, ://www.bcm.tmc.edu/crowd/ Current Access for All: Developing Systems Change community partnerships include:
•
NC Coalition Against Domestic Violence
•
Alliance of Disability Advocates, Center for Independent Living
•
NC Coalition Against Sexual Assault
EQUALITY WHEEL: PEOPLE WITH DISABILITIES AND THEIR CAREGIVERS O NONVI LENCE NEGOTIATION AND FAIRNESS: Discussing the impact of the caregiver’s actions with the person. Accepting change. Compromising. Seeking mutually satisfying resolutions to conflict. Using positive reinforcement to affect change.
NON-THREATENING BEHAVIOR: Creating a safe environment through words and actions. Treating property, pets, and service animals with care. Having no weapons on the premises.
CHOICE AND PARTNERSHIP: Listening to the person. Acting as agent of person rather than agency. Sharing caregiving responsibilities with other caregivers and family. Being a positive, non-violent role model. Encouraging the person to speak freely and to communicate with others. Focusing on the person’s abilities and maximizing their independence.
ECONOMIC EQUALITY: Acting responsibly as fiscal agent. Developing a plan where access to money or property is not contingent on appropriate behavior. Having purchasing decisions represent preferences/needs of the person. Advocating and brokering all possible resources of the person. Sharing and explaining financial information.
DIGNITY AND RESPECT:
EQUALITY with interdependence
RESPONSIBLE PROVISION OF SERVICES:
Using medications properly. Maintaining and using equipment in timely and appropriate manner. Encouraging access to and use of adaptive equipment. Showing sensitivity to the person’s vulnerability when providing care.
Encouraging positive communication. Honoring culture, tradition, religion, and personal tastes. Allowing for differences. Developing service and behavior program collaboratively.
INVOLVEMENT: Encouraging personal relationships. Assisting in gaining access to information and employment. Facilitating involvement within residence and job site. Encouraging contact with the case manager or advocate.
HONESTY AND ACCOUNTABILITY: Admitting being wrong. Understanding that everyone has feelings. Being flexible in policies and practices. Using positive behavioral practice. Communicating openly and truthfully. Acknowledging that abuse is never an acceptable practice.
NONVIOLENCE Developed by: Wisconsin Coalition Against Domestic Violence 307 S. Paterson St., Suite 2, Madison, WI 53703 608-255-0539 Based on the model by the Domestic Violence Intervention Project, Duluth, MN.
Produced and distributed by: 4 6 1 2 S h o a l C r e e k B l v d . • A u s t i n , Te x a s 7 8 7 5 6 512.407.9020 (phone and fax) • www.ncdsv.org
2006
Grateful Thanks to: Iowa Law Enforcement Academy for the original booklet on which this Maine version was based;
Vanessa Kalter-Long and Alyssa Gagnon, Student Interns With Contributions From:
Cumberland County Violence Intervention Partnership Maine Coalition Against Sexual Assault Maine Coalition Against Domestic Violence Portland Department of Public Safety
Illustrations :
Claire Brassil & Annie Sibley O’Brien Computer Coordination & Clipart: Jane Malinowski DHHS Non-Discrimination Notice The Department of Health and Human Services (DHHS) does not discriminate on the basis of disability, race, color, creed, gender, sexual orientation, age, or national origin, in admission to, access to, or operations of its programs, services, or activities, or its hiring or employment practices. This notice is provided as required by Title II of the Americans with Disabilities Act of 1990 and in accordance with the Civil Rights Act of 1964 as amended, Section 504 of the Rehabilitation Act of 1973, as amended, the Age Discrimination Act of 1975, Title IX of the Education Amendments of 1972 and the Maine Human Rights Act and Executive Order Regarding State of Maine Contracts for Services. Questions, concerns, complaints or requests for additional information regarding the ADA may be forwarded to DHHS’ ADA Compliance/EEO Coordinators, #11 SHS-221 State Street, Augusta, Maine 04333, 207-287-4289 (V), 207-287-3488 (V), 1-800-606-0215 (TTY). Individuals who need auxiliary aids for effective communication in program and services of DHHS are invited to make their needs and preferences known to the ADA Compliance/EEO Coordinators. This notice is available in alternate formats, upon request. To order additional copies of this publication, please e-mail Meryl Troop:
[email protected] or call (207) 557-0232 (V) or (866)241-8639 (TTY)
Domestic Violence Pictorial Interview Booklet For: State of Maine Law Enforcement Domestic Violence Advocates and Interpreters For use with interpreters and: People who are Limited English Proficient, Deaf or Speech Impaired Piloted and Funded by: Department of Health and Human Services Cumberland County Violence Intervention Partnership
Available online at: http://www.maine.gov/dhhs//bds/mhservices/MulticulturalResource/DV/index.html.
Table of Contents Topic
Page Number
Instructions.....................................................................................................................1 Married?.........................................................................................................................2 Divorced? .......................................................................................................................3 When Divorced/Separated? ..........................................................................................4 Living Together? ............................................................................................................5 Same Sex Couple? .........................................................................................................6 Children?........................................................................................................................7 Pregnant?........................................................................................................................8 Cruelty to Animals?........................................................................................................9 Object Thrown at Victim? .............................................................................................10 Pushed ............................................................................................................................11 Grabbed (from front)? ...................................................................................................12 Pulled Hair? ................................................................................................................... 13 Backhanded?..................................................................................................................14 Slapped Face? ................................................................................................................15 Punched?........................................................................................................................16 Kicked? ..........................................................................................................................17 Choked? .........................................................................................................................18 Choked and held on floor..............................................................................................19 Strangled (Choked) ........................................................................................................20 Weapons? ......................................................................................................................21 Hand Gun Pointed at Victim? .......................................................................................22 Rifle Pointed at Victim? .................................................................................................23 Threatened with knife? ..................................................................................................24 Abuser Threatened Suicide? .........................................................................................25 Area Injured ................................................................................................................... 26 Has he (the abuser) done this before? ...........................................................................27 Are you afraid of him (the abuser)? ...............................................................................28 Do you want to go? ........................................................................................................29 Effective language to Describe Domestic Violence .......................................................30 Interview Questions for Strangulation ...........................................................................32 Domestic Violence Response: Best Practices for Law Enforcement in Maine.............33 Human Trafficking: Questions and Hotline Information .............................................35 Interpreters: Telephonic & on Site ................................................................................36 ME Domestic Violence Victim Services Providers Address, Website & Telephone Number ................38
INSTRUCTIONS This packet of illustrations is designed to assist communication in a domestic violence incident when one or more of the parties do not speak English. The illustrations were not designed as a substitute for an interpreter and victim-advocate, only to assist officers in communicating before assistance from an interpreter can be obtained, or as a tool to be used by the interpreter. To use this instrument: 1. Display the illustrations to the victim and note the physical and emotional response given. 2. Next, note whether the victim affirms or denies the action in the illustration. 3. Then log the page number and indicate the response. 4.Finally, use the information gathered from this packet and, together with the other evidence gathered at the scene, determine your course of action.
Maine Domestic Violence Hotlines See back cover Maine Sexual Assault Hotline 1-800-871-7741 Language Line Telephone Interpreters..1-800-874-9426 ♣♣♣♣♣♣♣♣♣♣♣♣♣♣♣
Police: 911 Tape Saved? Considering that 90% of all battering victims are women and the remaining 10% are men1, it is a matter of statistical correctness that the illustrations of violence contained hereafter depicts the victim as a woman. Domestic Violence occurs in same-sex couples as well as heterosexual couples.
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1
Kirschman, Ellen. “I Love a Cop”. Guilford Press: 1997 p. 142
Married? (2)
Divorced? (3)
When Divorced/ Separated? (4)
Living Together ? (5)
Same Sex Couple? (6)
Children? (7)
Pregnant? (8)
Cruelty to Animals? (9)
Object Thrown at Victim? (10)
Pushed? (11)
Grabbed? (from front) (12)
Pulled Hair? (13)
Backhanded? (Struck in face with open hand) (14)
Slapped Face? (15)
Punched? (Closed Fist) (16)
Kicked? (17)
Choked? (from front with hand) (18)
Choked and held on floor? (19)
Strangled (Choked)? (from behind with forearm) (20)
Weapons? (21
Hand Gun Pointed at Victim? (22)
Rifle Pointed at Victim? (23)
Threatened with Knife? (24)
Abuser Threaten Suicide? (25)
Point to Area Injured (26)
Has he (the abuser) done this before? (27)
Are you afraid of him (the abuser)? (28)
(Hospital)
(Police)
(Safe House) Do you want to go to…? (29)
Effective Language to Describe Domestic Violence • • • • • • • • • • • • • • • • • • • • •
Grabbed, pushed, pulled, jerked, shoved By force, coerced Forceful strike, hit with fist/back of his fist, closed fist Back-handed me Choking (i.e. strangulation) Beating Bruises head to toe Swollen, eye swollen shut, face was swollen everywhere Throbbing, life-threatening injuries Bloody, saturated in blood, hair matted with blood The worst crime scene I’ve ever seen Sobering Defendant’s use of a weapon for protection in the neighborhood He cut the telephone wires, he broke the lock, he kicked in the door He went into a rage Defendant said he was “not done” with the victim Irritated Jealous Truly loved her To survive, a good actress Reunite with defendant
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Effective Language to Describe Domestic Violence (cont.)
Description of victim’s reaction • • • • •
Dazed, confused, scared, afraid, terrified Couldn’t work for a month Bawling Curled up in a ball Borderline hysteria
Victim Statements • • • •
I knew he wasn’t going to let me live. I couldn’t breathe. I didn’t deserve what he done to me. He said he would rip my heart out and feed it to me.
Offender Statements • • • •
She won’t be back It’s going to happen here. If I can’t have you, no one will. We belong together.
• • • •
Breathing heavily Like hit by a truck Headache for days Couldn’t go back to work
• He had that look in his eye. • I could tell that he was very angry. • He had his hands around my neck.
• No one will love you as much as I do. • I’ll come and find you and I’ll kill you. • I just killed my wife.
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Interview Questions for Strangulation ASK every victim of domestic abuse whether she was “choked”
When a victim says she was “choked”, an officer should ask the following questions: • • • • • • • • • • • • •
Can you describe in detail how the suspect strangled the victim? Did the offender use one or two hands? How much force was used? How hard did the offender grab the victim’s throat? How much shaking? (little to whipping back and forth) Did the victim have difficulty breathing during the incident? Did the victim report urinating or defecating during the incident? Did the victim feel light headed, faint, or lose consciousness? Did the victim become nauseous or report vomit? Any trouble swallowing or raspy voice? Any incident of strangulation before this one? Was the suspect wearing rings? Were there any corroborating witnesses?
Have you described the victim’s injuries in written detail and photographed them? Have you taken follow-up photos? (1-3 days later) If an object was used, was it photographed and seized?
Officers should always refer the victim for medical treatment and for domestic violence services from the agencies listed on the back page.
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Domestic Violence Response: Best Practices for Law Enforcement in Maine I INITIAL RESPONSE A. B. C. D. E.
Secure the scene and restore order Locate parties upon arrival and separate them Secure all weapons Assess medical needs of parties Note excited utterances–exact words by all parties including children, and all parties’ emotional and physical condition F. Never use children, or the other party, or friends of either party as interpreter. Use telephonic interpreters to ensure neutrality and to obtain accurate statements. Wait for legally qualified sign language interpreter to arrive on scene. II AT-SCENE INVESTIGATION A. 1.
Interviews -- video or audiotape preferred Victim and Suspect a. Interview twice to test consistency of statements –determine what occurred with detailed description of the crime(s) b. Determine history of abuse -include convictions, arrests, time in jail, undocumented/unreported acts of abuse, and any other dynamics of power and control observed at scene c. Note offender risk factors for dangerousness – stalking behaviors, victim fears offender, escalating violence, victim pregnant, multiple law enforcement involvement, access to weapon, substance abuse, threats to kill self/other/children, cruelty to animals, depression/mental illness, recent separation/divorce in relationship, PFA/PFH order in effect d. Check NCIC for warrants and PFA orders 2. Children (in the home, even if not present at the scene) a. Names and dates of birth b. Current/historical abuse that the children have witnessed c. Talk to children about their safety 3. Other witnesses at the scene a. Family b. Friends c. Neighbors B. Make the predominant aggressor determination 1. Investigate possibility of self-defense or human trafficking by either party (see page 35) 2. Note the relative strength of each party 3. Note the nature and severity of any injuries – look for self defense injuries 4. Determine credibility and ability 5. Determine the history of abuse and likelihood of future harm 6. Avoid temptation to believer the party with the best English communication skills. C. 7. 8. 3. 4.
Obtain written statements at the scene – do not leave affidavits to be filled out later Record or document suspect’s statement, interpreter’s name and credentials. Record or document victim’s statement, interpreter’s name and credentials. Determine where suspect lived previously – to locate priors and determine felon status Obtain name/contact information of someone who always knows how to reach victim (33)
Best Practices for Law enforcement in Maine (continued) D. 1.
2. 3. 4.
Collect and Preserve All Relevant Evidence Photograph the crime scene a. All parties including children to show injury and demeanor – for use at bail hearings, trial, sentencing b. Property damage Seize weapons used Collect damaged property Collect other pertinent physical evidence – hair, blood, torn clothing etc.
E. 1. 2. 3. 4. 5. 6. 7.
Possible actions at the scene Arrest Serve trespass/harassment notice Transport for medical attention Obtain medical release from victim Complete jail phone block form with victim Provide referral information for PFA/PFH order Provide referral information for local domestic violence project, sexual assault center, and/or batterers intervention program (see back page) 8. Complete victim consent form to have domestic violence advocate make follow-up contact with victim 9. Report Human Trafficking-hotline 1-888-3737-888 (see page 36) III. REPORT WRITING CHECKLIST A. Note who called the police B. Note the names, dates of birth, and relationship between parties – note elder abuse and gay/lesbian/bisexual/transgender C. Note the times of the incident, arrival, and statements – for excited utterance purposes D. Describe the scene/all crimes – note occurrence of strangulation E. Describe injuries, medical attention, and emotional states of parties F. Note the use of weapons G. Note alcohol/drug use H. Note bail status and conditions, probation status and conditions, and PFA/PFH order status and conditions I. Victim and suspect statements J. Information from children and other witnesses K. Photographs and other relevant evidence L. Probable cause determination for each arrested party M. Attach criminal records checks – SBI, Triple-I N. Interpreter Documentation – name, agency (if any), contact information, license number (sign language only)
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Best Practices for Law Enforcement in Maine (continued) IV. FOLLOW-UP A. Bail 1. Give bail commissioner detailed information including victim’s name, date of birth, address and phone number, language spoken, exact relationship to offender, history of domestic violence, and any probation, bail, or PFA order conditions 2. Ask for appropriate bail conditions – for example: no contact direct or indirect with the victim, no returning to residence, no possession/consumption of alcohol or drugs, no possession of firearms B. Notify victim upon receiving information from correctional facility re: suspect’s release C. Advise local domestic violence investigator of the case D. Collect 911 tape and other audio/video evidence E. Follow-up with victim and take additional photographs of injuries F. Interview and obtain written statements from EMTs – including run sheets – and communications officers/dispatchers G. Obtain medical records and ER photographs H. Deliver victim consent form to domestic violence project for follow-up contact I. Refer to victim-witness advocate for follow-up contact J. Report to DHHS – Child Protective Services 1-800-452-1999; Adult Protective 1-800-6248404 K. Follow up for federal prosecution This Best Practices protocol was adapted from “Peace In Our Families” – a collaborative of representatives from statewide domestic violence task forces – and has been endorsed by the following groups: Maine Chiefs of Police Association, Maine Coalition Against Sexual Assault, Maine Coalition to End Domestic Violence, Maine Commission on Domestic and Sexual Abuse, Maine Prosecutors Association, Maine Sheriffs Association, Maine State Police, Office of the Attorney General, Office of the U.S. Attorney. The template for this protocal is available from the Maine Criminal Justice Academy – revised 1/03, adapted for this publication 3/06
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HUMAN TRAFFICKING LOOK BENEATH THE SURFACE The person you have encountered or taken into custody may be a victim of human trafficking. The Trafficking Information and Referral Hotline will help you determine if you have encountered victims of human trafficking, will identify local resources available to help victims, and will coordinate with local social service organizations to assist victims so they can begin the process of restoring their lives. Victims you identify and assist may help the prosecution and conviction of their traffickers. Trafficking Information and Referral Hotline, 1-888-3737-888 These questions may help you identify a trafficking victim: • • • • • • • • •
What type of work do you do? Are you being paid? Can you come and go as you please? Have you or your family been threatened? What are your working and living conditions like? Where do you sleep and eat? Do you have to ask permission to eat/sleep/go to the bathroom? Are there locks on the doors/windows so you cannot get out? Has your identification or documentation been taken from you?
If you think someone is a victim of human trafficking, call the Trafficking Information and Referral Hotline, 1-888-3737-888, to obtain information and to access supportive services for the victim. If you are not in a position to question a potential victim of human trafficking, look for the following clues: • • • • • •
Evidence of being controlled Evidence of inability to move or leave job Bruises or other signs of physical abuse Fear or depression Not speaking on own behalf and/or non-English speaking No passport or other forms of identification or documentation (35)
Interpreters: Telephonic and On-Site Maine Interpreter Referral Agencies - Sign Language: Pine Tree Society – Interpreting Services - Phone: 885-0536 www.pinetreesociety.org Certified Interpreting – Phone: 798-7995 www.certifiedinterpreting.com Bangor Interpreting Agency – Phone: 207-989-8888 www.bangorinterpreing.com
Maine Interpreter Referral Agencies - Spoken Languages: Catholic Charities Maine/RISinterpret – southern Maine, 35 languages Phone: 523-2717 Fax: (207) 774-7166 http://www.ccmaine.org/RISInterpret Maine S.A.F.E. – Spanish and Portuguese in central and northern Maine Phone: 634-3326 FAX: 634-5389;
[email protected] Bangor Interpreting Agency – Phone: 207-989-8888 www.bangorinterpreing.com
National Telephone Interpreters – 24/7 Language Line - Phone: 1-800-874-9426 (Operator Access); 1-800-367-9559 (Automated Access), www.languageline.com Certified Languages International - Phone: 1-800-CERTIFIED, 1-800-237-8434 Fax: 1-800-362-2941 www.clilang.com Pacific Interpreters - Phone: 1-800-870-1069 www.pacificinterpreters.com
FAQ How is my call connected to a telephone interpreter? You simply dial a toll-free number, provide your account information and request the language needed. In seconds you will be connected to an interpreter. If you need help at any time identifying the limited English speaker’s language, just ask or say “Help” and a Customer Agent, trained in language identification will help you. If you are face-to-face with the limited English speaker, you may be able to guess what part of the world the person comes from and use the Language ID Card to pinpoint the language needed. Also, knowledge of the demographics of your customer base is helpful. A speaker phone makes it easier for all to hear at once; a cell phone or land line can be handed back and forth for the interpretation to take place if no speaker phone is available. How long does it take to reach a telephone interpreter? On average, you are connected to an interpreter within seconds once your account information is taken. Occasionally the connection time for a less commonly requested language may be a bit longer. Can I reach an interpreter at night or on weekends? The national telephone agencies operate 24/7/365. On rare occasions, all interpreters for a particular language may be busy and you’ll be asked to call back in a few minutes. For sign language, on-site interpreters are available on-call for emergencies. Some agencies have videoconferencing capability and can connect you with an interpreter through the videoconferencing equipment at a local hospital. What if it turns out I requested the wrong language? Ask the interpreter to route you back to the Customer Service Agent for assistance. If you know the correct language, say the name of the language and proceed as usual. If you’re unsure of the correct language, ask for a customer service agent trained to help in language identification. (36)
What happens if we have a problem hearing one another on a call? Relay the appropriate instructions to the limited English speaker as to how you will re-establish contact. Say “end of call” to your interpreter and hang up. Then redial and ask the Agent to place your call and monitor it for sound quality. What should I do when the interpreter joins the conversation? Start by briefing the interpreter. Summarize what you wish to accomplish and give any special instructions. Don’t assume that the interpreter or limited English speaker knows more about your organization or its procedures than what you tell them. Take the lead in the conversation. Give the interpreter specific questions to relay. Group your thoughts or questions to help the conversation flow naturally and quickly. For example, ask for an address and phone number as one question. Speak directly to the Limited English Proficient person, rather than asking the interpreter “ask him if…” or “tell her that… What guarantee of confidentiality do I have? Generally, each interpreter signs a confidentiality agreement with the referral agency and is bound by a strict Code of Ethics, ensuring that all information pertaining to the work we do for you remains strictly confidential. Interpreters routinely destroy all notes. What should I do to facilitate the interpretation? Avoid slang, jargon, acronyms or technical terms that may not interpret well into other languages and cultures. As you would in any conversation, you may have to clarify points the limited English speaker doesn’t readily understand. If you need to clarify a point, ask the interpreter right away, don’t wait, as it is difficult for an interpreter to both interpret and recall the conversation. Professional interpreters are trained to ask for clarification if you use a term they do not know. Are calls recorded? No. However, you are free to record from your end, consistent with any legal stipulations. What do I need to document? Telephone interpreters often have an Interpreter Identification Number, and also identify themselves by first name. Write down the interpreter Identification Number and the agency used for future reference. For on-site interpreters, note name, agency and contact information. Who pays for this service? The entity providing the service (law enforcement, DV agency, medical care, etc.) pays for the interpreter service, never the Limited English Proficient or Deaf person. Calls to interpreter agency 800-numbers are free. Telephone interpreter usage is billed in one-minute increments and charges begin when the interpreter comes on the line. On-Site interpreter agencies often have one-hour minimum charges as well as travel time and perhaps transportation costs. Your bill will list the date, time and duration of the call, language, interpreter number, and the name of the person requesting the interpreter. All entities should have policies and procedures in place to handle interpreting issues such as payment, authorization, when interpreters are needed, etc.
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MAINE DOMESTIC VIOLENCE VICTIM SERVICES PROVIDERS ADDRESS, WEBSITE & TELEPHONE NUMBERS
Abused Women’s Advocacy Project
Spruce Run
(Oxford, Franklin & Androscoggin Counties) P.O. Box 713 Auburn, ME 04212-0713 Administrative Telephone #: 207-795-6744 www.awap.org Hotline #: 1-800-559-2927 or 207-795-4020
(Penobscot County) P.O. Box 653 Bangor, ME 04402 Administrative Telephone #: 207-945-5102 www.sprucerun.net Hotline #: 1-800-863-9909 or 207-947-0496
Battered Women’s Project
The Next Step
(Aroostook County) 421 Main Street, Suite 2 Presque Isle, ME 04769 Administrative Telephone #: 207-764-2977 no website Hotline #: 1-800-439-2323
(Hancock & Washington Counties) P.O. Box 1465 Ellsworth, ME 04605 Administrative Telephone #: 207-667-0176 www.nextstepdvproject.org Hancock County Hotline #: 1-800-315-5579 or 207667-4606
Caring Unlimited (York County) P.O. Box 590 Sanford, ME 04073 Administrative Telephone #: 207-490-3227 www.caring-unlimited.org Hotline #: 1-800-239-7298 or 207-324-1802
P.O. Box 303 Machias, ME 04654 Administrative Telephone #: 207-255-4934 Washington County Hotline #: 1-888-604-8692 or 207255-4785
Family Crisis Services
(Piscataquis County) P.O. Box 192 Dover-Foxcroft, ME 04426 Administrative Telephone #: 207-564-8165 www.wmncare.org Hotline #: 1-888-564-8165 or 207-564-8165
Womancare
(Cumberland & Sagadahoc Counties) P.O. Box 704 Portland, ME 04104 Administrative Telephone #: 207-767-4952 www.familycrisis.org Hotline #: 1-800-537-6066 or 207-874-1973
----------------------------------------------------------------------------------------Maine Coalition to End Domestic Violence 170 Park Street Bangor, ME 04401 207-941-1194 www.mcedv.org This Statewide Coalition does administrative work – does not provide direct services
Family Violence Project (Kennebec & Somerset Counties) P.O. Box 304 Augusta, ME 04332 Administrative Telephone #: 207-623-8637 www.familyviolenceproject.org Hotline #: 1-877-890-7788 or 207-623-3569
New Hope For Women (Knox, Lincoln & Waldo Counties) P.O. Box A Rockland, ME 04841 Administrative Telephone #: 207-594-2128 www.newhopeforwomen.org Hotline #: 1-800-522-3304 or 207-594-2128 (38)
How can domestic violence agencies better serve people with disabilities? Ask everyone you serve the following question: “We are working to become more accessible. Will you need any assistance while receiving services from our agency?” If the person requires simpler language, ask “Will you need any extra help?” Listen to any instructions the person may give about how you can assist. Examples might include helping the person enter the building, providing large print materials, or requesting an assistive listening device during court procedures.
What resources are available to assist domestic violence agencies to better serve survivors with disabilities? NC Coalition Against Domestic Violence 1-888-232-9124 www.nccadv.org NC Office on Disability and Health 919-843-3882 (Voice) 919-843-3531 (TTY)
[email protected] www.fpg.unc.edu/~ncodh/
Domestic Violence and People with Disabilities
Insert local program information here:
When serving a client with a disability, domestic violence advocates should follow these guidelines: •
Regard the person as an equal individual. Reject the common view that a person with a disability needs to be “fixed” or pitied.
•
Assume that all people with disabilities are capable. Help each person identify her/his strengths and capacities and build on them.
•
Respect the person’s struggle as well as her/his strength as a survivor.
•
Allow the client to identify issues to address. Don’t assume that the issues are disability-related.
•
Accept and defend the right of all people with disabilities to control their own lives.
Whenever possible, NCCADV will make this brochure available in alternate formats (such as large print, audio, diskette) upon request.
This brochure was developed by the North Carolina Coalition Against Domestic Violence and the North Carolina Office on Disability and Health, a partnership between the North Carolina Department of Health and Human Services, Division of Public Health and the University of North Carolina at Chapel Hill FPG Child Development Institute. This brochure was funded by the NC Governor’s Crime Commission, Award No. 180-1-05-4VC-AW-405, awarded by US Dept. Of Justice, NC Dept. Of Crime Control and Public Safety / Governor’s Crime Commission to the University of North Carolina at Chapel Hill. This brochure was also supported by Grant/ Cooperative Agreement No. U59/ CCU419404-04 from the Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities to the NC Dept. of Health and Human Services, Division of Public Health.
North Carolina Coalition Against Domestic Violence
Did you know? •
About 85% of women with disabilities have experienced domestic violence. 1
•
Sixty-two percent of a national sample of women with physical disabilities reported having experienced physical, sexual or emotional abuse. 2
•
How might people with disabilities be vulnerable to domestic violence? 4 •
•
Adults with developmental disabilities have 4-10 times the risk of physical/sexual assault. 3
What is disability? Disability can be a physical, mental health, cognitive, or sensory condition that limits walking, thinking, seeing, talking, hearing, and/or everyday activities. Some disabilities are present at birth; others come later in life and may result from domestic violence. Some disabilities are visable while others may not be seen.
•
•
•
•
Persons who are deaf or who have a speech disability may not be able to report abuse or seek services due to communication barriers.
What other types of abuse may people with disabilities experience along with the domestic violence? 4 •
Taunting about the disability
•
Withholding medication
Individuals with intellectual disabilities often reside in group homes where they are vulnerable to abuse by staff, caregivers or other residents. They are often taught to be obedient and may be overly trusting of others.
•
Threatening to place the person in a residential facility
•
Withholding personal care or assistance (i.e. refusing to prepare meals or bathe the person)
Persons with physical disabilities may depend on others to meet their basic needs such as bathing or toileting, making them vulnerable to abuse. They may also be less able to defend themselves or escape violent situations.
•
Withholding needed medical equipment like walkers, canes or wheelchairs
•
Rough handling such as causing physical pain during routine care
Persons with disabilities may lack knowledge about their bodies, healthy relationships, and how to protect themselves.
•
Withholding benefits/money or controlling the person’s finances
•
Withholding access to communication such as sign language interpreters and relay phone services
•
Denying right of choice on reproductive issues
Persons with disabilities may stay longer in an abusive situation and have fewer options for safety due to barriers at a domestic violence agency or in the community. Individuals with disabilities may be perceived by offenders as easy targets.
1 Feuerstein, 1997 2 Nosek, M. & Howland, C., 1998 3 Office of Victims of Crime Bulletin, 1998 4 Disability Services ASAP (A Safety Awareness Program) of SafePlace in Austin, Texas
INCREASING AGENCY ACCESSIBILITY FOR PEOPLE WITH DISABILITIES
Domestic Violence Agency Self-Assessment Guide Revised 2004
Cathy Hoog, Abused Deaf Women’s Advocacy Services, for the Washington State Coalition Against Domestic Violence
TABLE OF CONTENTS Acknowledgements .............................................................................................1 How to Use this Self-Assessment Guide...........................................................2 Increasing Awareness of Staff.............................................................................5 Getting to the Agency ........................................................................................10 Getting Around Inside the Building ................................................................16 Using Domestic Violence Program Services...................................................29 Getting the Message Out ...................................................................................42 Reviewing Existing Policies and Procedures..................................................47 Congratulations! ................................................................................................53 Resources for Information on Increasing Access ...........................................54 Resources on Federal Disability Rights Laws ................................................56 References ............................................................................................................58
ACKNOWLEDGEMENTS The Washington State Coalition Against Domestic Violence is indebted to author and project cocoordinator, Cathy Hoog, the Community Advocacy Coordinator at Abused Deaf Women’s Advocacy Services, for her tireless work and extraordinary insights in creating this document. This guide is a critical tool that will guide advocates and domestic violence agencies in their efforts to improve accessibility for all victims of domestic violence. The Washington State Coalition Against Domestic Violence is appreciative of the critical thinking and goodwill of the members of the advisory committee who have given their time, expertise and support for this project. Special thanks also go to Christine Olah of WSCADV for formatting and editing this guide. Advisory Committee: Cathy Hoog, Disability Project Co-Coordinator and Community Advocacy Coordinator, Abused Deaf Women’s Advocacy Services Laura Law, Director of Housing Support Services and Advocate, YWCA Anita Vista Transitional Housing Program David Lord, Attorney, Washington Protection Advocacy Services Karen Mitterer, Private Attorney, Disability Advocacy Ginny Ware, Transitional Housing Program Manager, New Beginnings for Battered Women and their Children Leigh Nachman Hofheimer, Disability Project Co-Coordinator, Washington State Coalition Against Domestic Violence
This project was supported by funding from the Washington State Department of Social and Health Services, Children’s Administration, Division of Program and Policy. The points of view presented in this document are those of the author and do not necessarily represent the official position or policies of the Washington State Department of Social and Health Services. This project was supported by Grant No. 2002-FW-BX0006 awarded by the Violence Against Women Office, Office of Justice Programs, U.S. Department of Justice. Points of view in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice. Permission to reproduce any portion of this guide is granted, on the condition that the Washington State Coalition Against Domestic Violence and author Cathy Hoog are credited.
Increasing Agency Accessibility for People with Disabilities: DV Agency Self-Assessment Guide Washington State Coalition Against Domestic Violence
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HOW TO USE THIS SELF-ASSESSMENT GUIDE "No pessimist ever discovered the secret of the stars, or sailed to an uncharted land, or opened a new doorway for the human spirit." Helen Keller (1880-1968), American author and educator who was Deaf-blind Providing domestic violence services to people with disabilities challenges our thinking about the experience of abuse and our strategies for reform. We can be proud of Washington State and its excellent policies against abuse. We are doing enough, it would seem, but it is not enough for people with disabilities. The aren’t many practical tools available for domestic violence programs for improving accessibility. The Coalition developed this tool specifically for you to increase your program’s ability to work with people with disabilities. By increasing our capacity to work with victims who have a disability, we engage in creative and resourceful advocacy with every individual who seeks justice and safety. This self-assessment guide is intended to assist domestic violence programs in evaluating their accessibility to victims with disabilities in their community. The Americans with Disabilities Act (ADA) requires programs to be accessible to people with disabilities. Domestic violence programs should eliminate physical barriers to access. Communications by program staff with people with disabilities should be at least as effective as communication with those who do not have disabilities. Policies and practices should be reviewed to eliminate unnecessary barriers to accessing services. The best way to comply with the requirements of the ADA is to do a thorough self-assessment, and develop a prioritized plan for making the program accessible to all persons with disabilities. It is important to remember that people with disabilities are first of all individuals! Meaning that they each have their own ideas about what accommodations are preferable. You should have a goal of making things flexible to accommodate a variety of possible requests. It is impossible to make blanket changes that will make your agency accessible to all people with disabilities. You will have to remain open to changes that are necessary based on individual preference and need.
This document is intended solely as a guide and is not a statement of your legal responsibilities or rights. Completion of the steps identified in the guide does not necessarily mean you have met the requirements of the Americans with Disabilities Act, other state or federal laws or regulations.
Agencies can receive additional help by contacting the ADA Technical Assistance Centers at 1-800949-4ADA. This toll-free number will connect you to your nearest Disability and Business Regional Technical Assistance Center. Regional centers may be able to provide the information or refer the agency to other experts. Additionally, the agency can contact a local Independent Living Center (See Resources section of this guide) and arrange for a site visit, complete an evaluation or provide consultation. Inquire about costs, as there may be fees for services when using this resource. This guide discusses common problem areas and provides some suggestions for improving accessibility. The more barriers removed from the agency, the more options a victim with a disability will have for reaching safety. Current research has found that while abuse victims with disabilities may follow the same known patterns as abuse victims without disabilities, victims with
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disabilities were found to stay much longer in an abusive relationship.1 This same research cites a lack of accessible options available to victims with disabilities. Every single aspect addressed by an agency will bring the program farther along to building a pathway to safety for all victims.
1
“Preventing and Intervening with Violence Against Children and Adults with Disabilities,” A white paper for the conference, Arlington, VA, May 2002. Prepared by M. Nose, R., Hughes, H. Taylor and C. Holand, Center for Research on Women with Disabilities, Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, 3440 Richmond, Suite B, Houston, TX 77046,
[email protected].
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Getting Started: • • • • • • • • • • • •
Make a copy of the guide. Obtain a copy of site’s floor plan or make a sketch to help visualize which pathways should be accessible. Carry a tape measure, clipboard and a 60-inch circle of paper. Tour the entire site and conduct interviews to answer the questions in the guide. Sit down with decision makers and develop answers for addressing the "no" responses. Discuss your solutions and findings with an agency or person with disabilities who is familiar with access issues. When no immediate resolution is available, develop a contingency plan stating how the agency will accommodate persons with disabilities in the interim. Develop a written plan that is circulated at all levels of the agency and program detailing the immediate and long-range goals for improving accessibility. Prioritize deadlines, develop budget estimates, and decide who will be responsible for carrying out the plan. The board of directors should assist in developing the agency’s budget items included in the plan. The plan should be monitored regularly to measure progress and implementation of the action steps. Keep records of your planning and accomplishments for three years.
Directions: After answering each “yes, “ “no,” or “in progress” to each question, the box below should be completed. The box will help the agency develop short- and long-range goals for increasing accessibility. The meanings of the terms in the boxes are as follows: Action
Assigned to
Budget
Due
Immediate steps:
Long-term goals:
Immediate steps: Think about the steps you could make “tomorrow” if a person with a disability asks for accommodation. Document the needed action steps. Long-term goals: Document the agency’s agreed-upon solution for each accommodation issue. Assigned to: Record the initials of the person who will be responsible to carry out the action steps. This person could be a board member, a staff person, or a volunteer. Budget: Record the projected costs of the proposed action steps. Due: Record completion date. Use the guide as a problem-solving tool. Copy and distribute the guide throughout your agency.
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INCREASING AWARENESS OF STAFF This section focuses on staff awareness and training about the diverse experiences of people with disabilities who are also victims of domestic violence. There are many ways to increase staff knowledge about people with disabilities, and receive feedback from people with disabilities who use the program services.
1. Is your program actively working with organizations or groups serving people with disabilities? YES
NO
IN PROGRESS Action
Assigned to
Budget
Due
Immediate steps:
Long-term goals:
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Increasing Awareness of Staff
2. Is there an agency/person with a disability familiar with access issues to work with you on this self-evaluation and plan? YES
NO
IN PROGRESS Action
Assigned to
Budget
Due
Immediate steps:
Long-term goals:
3. Is someone in your agency designated to oversee compliance with laws like the ADA regarding accommodation of people with disabilities? YES
NO
IN PROGRESS Action
Assigned to
Budget
Due
Immediate steps:
Long-term goals:
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Increasing Awareness of Staff
4. Are there people with disabilities working in different levels of your agency? YES
NO
IN PROGRESS Action
Assigned to
Budget
Due
Immediate steps:
Long-term goals:
5. Has your staff training addressed the dual dynamics of abuse and the experiences of people with disabilities? YES
NO
IN PROGRESS Action
Assigned to
Budget
Due
Immediate steps:
Long-term goals:
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Increasing Awareness of Staff
6. Has your program staff had training by an agency or person with A disability who is familiar with access issues to increase comfort level, skills, awareness of rights and responsibilities, and general knowledge for working with victims with disabilities? YES
NO
IN PROGRESS Action
Assigned to
Budget
Due
Immediate steps:
Long-term goals:
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Increasing Awareness of Staff
IDEAS AND QUICK SOLUTIONS Figuring out how many victims with a disability use program services is one way to measure the agency’s connection to the disability advocacy community. Twenty percent of the United States population (43 million people) has a disability that affects the performance of their daily activities. Begin to dialogue and build alliances by attending a local disability networking meeting or calling a local agency that works with people with disabilities. Establishing alliances between local domestic violence agencies and disability agencies (that are by or for people with disabilities) fosters the development of a shared vision for working with victims with disabilities.
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GETTING TO THE AGENCY People with disabilities should be able to travel to approach the building, and enter as freely as everyone else. At least one route of travel should be both safe and accessible for everyone, including people with disabilities.
1. Is there a clear path of travel to your building that is clearly marked and does not use stairs? YES
NO
IN PROGRESS Action
Assigned to
Budget
Due
Immediate steps:
Long-term goals:
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Getting to the Agency
2. Is the route monitored regularly to ensure it is still usable and has not been blocked? YES
NO
IN PROGRESS Action
Assigned to
Budget
Due
Immediate steps:
Long-term goals:
3. Is the slope of travel to your building no more than 1:12 (i.e., no more than a one inch rise in height for each foot of distance to travel)? YES
NO
IN PROGRESS Action
Assigned to
Budget
Due
Immediate steps:
Long-term goals:
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Getting to the Agency
4. Where there are sidewalks and curbs -- are the curb cuts leading to your building entry clear of any blockages? YES
NO
IN PROGRESS Action
Assigned to
Budget
Due
Immediate steps:
Long-term goals:
5. Where there are parking lots, does your program have parking spaces for people with disabilities near the main building entrance? YES
NO
IN PROGRESS Action
Assigned to
Budget
Due
Immediate steps:
Long-term goals:
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Getting to the Agency
6. Is your doorway entrance at least 32 inches wide with no more than a ½ inch threshold between the outside and inside of the building? YES
NO
IN PROGRESS Action
Assigned to
Budget
Due
Immediate steps:
Long-term goals:
7. Are your building entry door handles easy to grasp and open (preferably a lever handle needing no more than eight pounds of pressure to operate)? YES
NO
IN PROGRESS Action
Assigned to
Budget
Due
Immediate steps:
Long-term goals:
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8. If your county has bus service or para-transit options for transporting people, does your staff know how to access the services? YES
NO
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9. If your agency provides transportation, does the program have a van with a lift or the ability to use one? YES
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IDEAS AND QUICK SOLUTIONS Change the entrance to an accessible and level part of the building. Temporarily build a short ramp over the curb until a curb cut is permanently installed. Install non-slip surface materials, including paint with grit. Installing offset hinges can widen a doorway. When immediate access is unavailable, install a call button with a sign stating "Ring for Assistance," in large, clear print. Reconfigure and repaint your parking lot to provide accessible spaces. Locate an accessible van and arrange to use it (i.e., for crisis intervention or appointments). Identify the closest, accessible bus routes and directions to the agency.
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GETTING AROUND INSIDE THE BUILDING This section focuses on how people with disabilities will reach all the parts of the building. Ideally, the layout of the building should allow people with disabilities to be as independent as possible in all the common areas (e.g., kitchen, laundry room, meeting areas, children’s play area, advocate’s office). A continuous corridor three feet wide and six to eight feet high, and free of hazards and abrupt changes in level, should connect all common areas of your program. This pathway should lead from the entry point of the property and through all the common areas. 1. Is the path of travel to all common areas in your building free of obstructions and at least 36 inches wide? YES
NO
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2. Are all objects on the walls protruding no more than four inches into the walkway? YES
NO
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3. Does your agency and staff systematically check for access each time things are moved around or remodeled? YES
NO
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4. Is the floor hard and non-slip? YES
NO
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5. Are all the doors to the common areas 32 inches wide? YES
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Getting Around Inside the Building
6. Do the doors have lever handles and open easily? YES
NO
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7. Do all the rooms have less than a ½ inch rise threshold between the corridor and entry? YES
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Getting Around Inside the Building
8. Is there a wide and unobstructed path between desks, tables, beds and other furniture groupings? YES
NO
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9. Does part of the corridor allow for turn-around room (at least five-foot circles)? YES
NO
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10. Are the elevator controls 48 inches from the floor? YES
NO
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11. Are tactile markings placed on the outside and inside elevator buttons? YES
NO
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Getting Around Inside the Building
12. Does your elevator have audible signals and a turning area of at least 60 inches? YES
NO
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13. Is your phone located in an unobstructed area with clear space of at least 30 inches by 48 inches in front of it and no more than 48 inches above the floor? YES
NO
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14. Are your agency’s phones push-button for dialing? YES
NO
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15. Is there a clear path of travel to the bathroom? YES
NO
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16. Is your bathroom large enough to turn around in (at least 51 inches)? YES
NO
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17. Are grab handles installed in the toilet stalls? YES
NO
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18. Are your sinks at least 30 inches high and clear underneath (so a person using a wheelchair can get their knees under the sink and reach the handles) and are the pipes under the sink covered with insulating material to prevent burns? YES
NO
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19. Are your soap dispensers, towels, and other needed items no more than 48 inches from the floor? YES
NO
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20. Are all your alarm systems audible and equipped with flashing lights? Is the emergency evacuation plan posted in an accessible area? YES
NO
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21. Has the functionality of your emergency evacuation plan been reviewed by an individual or agency that is familiar with the needs and access issues for people with differing abilities (such as cognitive, sensory, visual, Deaf and mobility disabilities)? YES
NO
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Getting Around Inside the Building
22. Are all the machines and appliance controls located in your common areas low enough and within reach (48 inches from the floor)? YES
NO
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23. Are all signs inside your building: a) located 60 inches from the floor, b) placed next to the latch side of the door, c) made with raised characters between 5/8 inch and 2 inches tall, and d) in Braille? YES
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IDEAS AND QUICK SOLUTIONS While answering the guide, it is helpful to have the building floor plans. If plans are not available, use graph paper to sketch the layout of all interior and exterior spaces used by the organization. Make notes on the sketch or plan while completing the guide. Determine if the program's funding sources have monies available for barrier removal. If not, research grants and programs to fund your barrier removal plan. Here are some simple suggestions to address interior building accessibility: • Tilt down the top of a mirror that is too high so it can be seen from a lower angle • To test a door, try opening it with one hand, held in a fist • Retrofit doorknobs with add-on lever extensions • Use an inexpensive force meter or a fish scale to measure the force required to open a door • Place something on the floor under any objects that are protruding from the walls • Provide cup dispensers for fountains with spouts that are too high • A pre-cut paper or fabric 60-inch diameter circle makes it easy to determine if there is an adequate turning radius for wheelchairs If the installation of a permanent ramp is not quickly achievable, a portable ramp should have railings and a stable non-slip surface. The slope of the portable ramp should not exceed one to twelve. Only trained staff should assist persons in safely using the portable ramp. Having an evaluation and plan are critical action steps that demonstrate the agency’s progress and good faith efforts to achieve accessibility and comply with laws. Plans should be kept for three years and include: the persons consulted, the external and internal areas reviewed, the identified problems and any modifications or changes.
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USING DOMESTIC VIOLENCE PROGRAM SERVICES Ideally, domestic violence programs should provide people with disabilities the same services and access to all common areas available to all others. Ask yourself, if I had a mobility, visual, sensory, or cognitive disability, what program elements would function as a barrier to accessing services? 1. Has your program worked with domestic violence victims with disabilities? YES
NO
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Using DV Program Services
2. Do you keep statistics on the number of victims with disabilities who use the program’s services? YES
NO
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3. Do you ask everyone if they need any accommodations during screening and intake? YES
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4. Do you have a system in place that informs all appropriate staff of accommodation requests and your response plan? YES
NO
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5. Do you have a resident plan that allows for 24-hour access to medications and medical equipment? YES
NO
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6. Can residents with restricted or special diets obtain access to food 24 hours a day? YES
NO
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7. Do any of your shelter’s televisions have closed-captioned text, and does your staff know how to turn the captioning option on and off? YES
NO
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8. Do you have one accessible bedroom in the shelter and transitional housing program? YES
NO
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9. If not, do you have a plan for housing a victim who needs an accessible space (keep in mind that services should be provided in an integrated setting and not further isolate a victim with a disability)? YES
NO
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10. Do you have a plan to provide personal attendant services and independent living support to victims with disabilities in your shelter? YES
NO
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11. Do you have a plan for locating assisted listening devices, real-time captioning, and readers? YES
NO
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12. Does your program make policy exceptions to allow accommodations such as service dogs, interpreters and personal care assistants in your confidential shelter? YES
NO
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13. Do all appropriate staff know how to send and receive a TTY call? YES
NO
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14. Does your crisis line have a TTY and a person trained to use it at all times? YES
NO
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15. Are your staff and volunteers trained on using the Washington State Relay system (especially staff or volunteers who are on-call)? YES
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16. Are the residents’ phones hearing aid compatible and is a TTY available with the same privacy as other phones? YES
NO
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17. Does your program have a plan for accessing qualified interpreters 24 hours a day? YES
NO
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18. Does your program have a plan for accessing state-certified interpreters for legal proceedings? YES
NO
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19. Are your program forms, handouts, and educational information available in alternate formats? YES
NO
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20. Does your program definition of “intimate partners” include personal care assistants? YES
NO
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21. Can your program work with male victims with disabilities? YES
NO
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22. Can your program work with a resident in a group home or nursing home facility? YES
NO
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IDEAS AND QUICK SOLUTIONS The Rural Housing Service works with a wide variety of public and non-profit organizations to provide housing options to communities throughout rural America. Organizations eligible to apply for RHS funds include local and state governmental entities; non-profit groups, such as community development organizations; associations, private corporations, and cooperatives operating on a not-for-profit basis; and Federally recognized Native American groups. Website: http://www.rurdev.usda.gov/wa/. State office: USDA - Rural Development, 1835 Black Lake Blvd. SW, Suite B, Olympia, WA 98512-5715; Phone: (360) 704-7740, Fax: (360) 704-7742, TTY: (360) 704-7760. Alternate formats can be created from current print materials by enlargement on a copier or forms can be printed from the computer in a larger font. Someone can read materials onto a cassette tape. High marks, large-font "presto" label makers and stick-on felt squares may be used to make tactile markings on equipment. There is a wide array of inexpensive equipment available for improving access that can be found on the Internet and at many community centers. If your shelter does not have 24-hour staffing, think about a medication locker or other secure system accessible only by the adult needing emergency access to medication. Arrange to use an accessible meeting room in a nearby building for events and support groups. Alternative methods for offering shelter, such as accessible motel/hotel rooms nearby should be considered only after all options for removing barriers have been found not to be readily achievable. Personal attendants should be able to provide the following support: Cooking, house cleaning, shopping, accompaniment, clerical skills (filing, writing, etc.), reading, lifting and transferring, feeding, bathing, dressing, bowel and bladder care, and paramedical support. The Job Accommodation Network has compiled extensive ideas for accommodating individuals with disabilities. For additional information and ideas on accommodation for many specific disabilities, see their website at http://www.jan.wvu.edu/media/ideas.html#dis. Increasing Agency Accessibility for People with Disabilities: Domestic Violence Agency Self-Assessment Guide Washington State Coalition Against Domestic Violence
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GETTING THE MESSAGE OUT Helping the community become aware of your program’s accessibility will send victims a clear message that they are welcome in your program.
1. Are there pictures of people with disabilities included in any of your materials? YES
NO
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Getting the Message Out
2. Do you include information about your accessibility in your presentations, publications, announcements, invitations, letterhead, brochures, and business cards? YES
NO
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3. Do you seek out captioned videos for educational presentations? YES
NO
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Getting the Message Out
4. Are your program’s materials and events available in alternate formats such as: audiotape, large print, Braille, computer disk, and website (if applicable)? YES
NO
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5. Do you provide interpreters for your community events? YES
NO
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Getting the Message Out
6. Do you do outreach in places used or frequented by people with disabilities? YES
NO
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Getting the Message Out
IDEAS AND QUICK SOLUTIONS Prepare a press release for the local media about what you have accomplished. Connect with your local disability services and subscribe to and advertise in their newsletters and websites. Avoid creating "special" brochures. Instead, integrate access accommodation information into the materials you already produce.
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REVIEWING EXISTING POLICIES AND PROCEDURES 1. Do any of your existing policies inadvertently exclude a person with a disability from your program or make your job harder when you try to help? YES
NO
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Reviewing Existing Policies and Procedures
2. Do you have a process to request a revision or exception to your policies, procedures or practices to accommodate an individual person’s disability? YES
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3. Have you reviewed your employment policies to be sure that they do not limit applicants or employees in a way that adversely affects their opportunities because of a disability? The review should include the following policies: recruiting, hiring, promotion, grievance, termination, and layoff policies. YES
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Reviewing Existing Policies and Procedures
4. Have you reviewed your program to make sure your daily practices and procedures do not have the effect of discrimination on the basis of a disability (for example, holding employment interviews in a non-accessible building or refusing to provide an interpreter)? YES
NO
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5. At your program, are staff and volunteers given an opportunity to ask about or make a request for accommodations? YES
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Reviewing Existing Policies and Procedures
6. At your program, are the people utilizing your services given an opportunity to ask about or make a request for accommodations? YES
NO
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7. Do your safety planning forms include questions about support and resources for victims with varied abilities? YES
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Reviewing Existing Policies and Procedures
8. Have you determined the process you will use to decide when reasonable accommodation would cause undue hardship for your program? Do you have a process to document that decision? YES
NO
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9. Has your staff been trained and updated on your program’s policies and everyday practical procedures regarding people with disabilities? YES
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10. Have you posted equal opportunity notices in an accessible format and advertised all position openings in diverse print media resources and varied locations? YES
NO
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IDEAS AND QUICK SOLUTIONS Obtain a copy of the WSCADV manual Enough and yet not Enough: An Educational Resource Manual on Domestic Violence Advocacy for Persons with Disabilities in Washington State, principal author, Cathy Hoog, June 2001. Contact Leigh Hofheimer at 206, 389-2515, ext. 104. Even if your agency is not easily made accessible, having a completed self-evaluation and a written plan of action will prove your good faith efforts to comply. Plans should be kept for three years and list the persons consulted, the areas considered, the problems identified and any modifications or changes.
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CONGRATULATIONS! Thank you for taking the time to complete this self-assessment guide. By reading through the guide, you have demonstrated your commitment to improving your program's services to victims with disabilities. You may now find yourself proud of your program’s progress, excited by the possibilities of expanding your program, or overwhelmed by the amount of work to be done. Support is available both in your community and at the Washington State Coalition Against Domestic Violence. Use this guide to develop a plan of action for your program to improve services to victims with disabilities. This guide includes creative solutions to remove obstacles to victim safety. Access does not have to be complicated, expensive or accomplished all at once. Start with what is feasible and affordable. You will find as you make connections that there are resources available to help you figure out what is best for your program. Statistics show that victims with disabilities stay in abusive relationships much longer than average and believe they have fewer options to reach safety. Every action you take will offer more options for safety to victims with disabilities.
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RESOURCES FOR INFORMATION ON INCREASING ACCESS Center For Independence 325 E. Pioneer Ave Puyallup, WA 98372(253) 435-8490 (253) 845-3174 TTY (253) 435-8590 FAX Web: http://www.geocities.com/centerind/index.html Email:
[email protected] Coalition of Responsible Disabled 612 North Maple Street Spokane, WA 99201(509) 326-6355 V/TTY (509) 327-2420 FAX Disability Resource Center 607 Southeast Everett Mall Way, #6C Everett, WA 98208(425) 347-5768 V/TTY (425) 710-0767 FAX (800) 315-3583 Web: http://www.wa-ilsc.org/ Email:
[email protected] Disability Resource Network 16315 NE 87th Street, # B-3 Redmond, WA 98052(425) 558-0993 V/TTY (425) 558-4773 FAX (800) 216-3335 Email:
[email protected] Central Washington Disability Resources 422 North Pine Street Ellensburg, WA 98926 (509) 962-9620 V/TTY (509) 933-1571 FAX (800) 240-5978 Email:
[email protected]
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Disability Resources of Southwest Washington 5501 NE 109th Court, Suite N Vancouver, WA 98662 (360) 694-6790 (360) 882-1324 FAX Email:
[email protected] Tacoma Area Coalition of Individuals with Disabilities 6315 South 19th Street Tacoma, WA 98466-6217 (253) 565-9000 (253) 565-5445 TTY (253) 565-5578 FAX Email:
[email protected] Washington Coalition of Citizens with Disabilities 4649 Sunnyside North, Suite 100 Seattle, WA 98103 (206) 545-7055 (206) 632-3456 TTY (206) 545-7059 FAX (866) 545-7055 Web: http://www.wccd.org Email:
[email protected]
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RESOURCES ON FEDERAL DISABILITY RIGHTS LAWS2 The Northwest ADA & IT Center is the federally designated Disability and Business Technical Assistance Center (DBTAC) for Region X, serving Alaska, Idaho, Oregon and Washington. Periodic Information Bulletins can keep you updated on current topics related to the Americans with Disabilities Act and accessible information technology. Resources can also be found through www.disabilityinfo.gov, a one-stop interagency web portal for people with disabilities, their families, employers, service providers, and others. The Architectural Barriers Act (ABA) requires access to certain facilities designed, built, altered, or leased with federal funds according to established design standards. These standards are enforced by the Access Board through the investigation of complaints. Technical assistance on the design requirements is also available from the Access Board. The Americans with Disabilities Act (ADA) prohibits discrimination on the basis of disability in employment, state and local government services, transportation, public accommodations, commercial facilities, and telecommunications. Unlike the ABA, the ADA's coverage is not tied to the presence of federal funding. Various agencies provide information or guidance on different sections of the law. Information on all sections is available through a network of regional Disability and Business Technical Assistance Centers (DBTACs) sponsored by the federal government. ADA Accessibility Guidelines, and Electronic & Information Technology Standards: Access Board www.access-board.gov, (800) 872-2253 (v), (800) 993-2822 (TTY) Employment: Equal Employment Opportunity Commission www.eeoc.gov, (800) 669-4000 (v), (800) 669-6820 (TTY) Government Services and Public Accommodations: Department of Justice www.ada.gov, (800) 514-0301 (v), (800) 514-0383 (TTY) Transportation: Federal Transit Administration www.fta.dot.gov, (888) 446-4511 (V/Relay) Telecommunication Relay Services: Federal Communication Commission www.fcc.gov, (888) 225-5322 (v), (888) 835-5322 (TTY) The Rehabilitation Act of 1973 ensures access to programs and activities that are federally funded. It also protects the rights of federal employees with disabilities. Federal agencies are responsible for enforcing requirements as they apply to their own programs, services, and employment practices. The law also requires electronic and information technology procured by federal agencies to be accessible according to standards issued by the Access Board. Programs and Activities: Each federal agency is responsible for ensuring that the programs and activities it funds meet the access requirements of Section 504 of the Rehabilitation Act of 1973. To
2
This information was excerpted from Information Bulletin #15, Northwest ADA & IT Center, January 6, 2003. To obtain more information or to be added to their mailing list, please contact
[email protected] or call (800) 949-4232.
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find an agency's 504 contact, call the Access Board or see this website link: www.access-board.gov/enforcement/504.htm. The Fair Housing Act prohibits discrimination in housing on the basis of disability, as well as race, color, gender, and religion. It covers housing in the public and private sectors. Under the law, new multi-family housing must be able to be adapted for accessibility according to established guidelines. Department of Housing and Urban Development www.hud.gov , (800) 669-9777 (v), (800) 927-9275 (TTY). The Telecommunications Act requires telecommunications products and services to be accessible according to guidelines developed by the Access Board, where readily achievable. It covers a broad range of products, including telephones, cellular phones, pagers, and fax machines. The Federal Communications Commission enforces requirements of the law. Federal Communications Commission www.fcc.gov, (888) 225-5322 (v), (888) 835-5322 (TTY). The Air Carrier Access Act prohibits discriminatory treatment of people with disabilities in air travel. Regulations issued by the Department of Transportation under the Act cover a range of issues, including boarding assistance and access features in newly built aircraft. Aviation Consumer Protection Division, Department of Transportation www.dot.gov/airconsumer, (866) 266-1368 (v), (866) 754-4368 (TTY) The Voting Accessibility for the Elderly and Handicapped Act ensures access to polling places used in federal elections and requires states to make available registration and voting aids, such as instructions in large type. Also, the Help America Vote Act of 2002 addresses access to polling places and voting systems. The Election Administration Commission, a new entity to be established under the law, will implement the act's reforms.) Voting Section, Civil Rights Division, Department of Justice www.usdoj.gov/crt, (800) 253-3931 (V/TTY)
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REFERENCES National Coalition Against Domestic Violence, “Access Survey & Planning Guide,” Open Minds, Open Doors: Technical assistance manual assisting domestic violence service providers to become physically and attitudinally accessible to women with disabilities. Denver, CO, 1996. U.S. Department of Justice, Americans with Disabilities Act, Information and Technical Assistance publications, December 2002, www.ada.gov/crt/ada/adahom1.htm.
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DVD’s For Law Enforcement, First Responders, and Advocates on Disabilities
Autism Awareness for Law Enforcement and Community Service Personnel .autismsociety-nc. Credo www.qualitymall.org Disability Awareness for Law Enforcement .ilea. End the Silence .disabilities.temple. Law Enforcement: Your Piece To The Autism Puzzle www.saharacares.net Project G.U.I.D.E. Communicating Effectively with Victims/Witnesses with Severe Disabilities (Barbara Wheeler, University of Southern California UCEDD at Children’s Hospital Los Angeles 323-669-2300,
[email protected]) Serving Crime Victims With Disabilities .ojp.usdoj.gov/ The Mirror Cracked: How to Recognize Exploitation, Neglect & Abuse .disabilityrightsnc. To Protect and Serve: An Introduction to People with Intellectual Disabilities .arcnc. Victims with Disabilities: Collaborative, Multidisciplinary First Response (March 2009) .ovc.gov/publications Victims with Disabilities: The Forensic Interview-Techniques for Interviewing Victims with Communication and/or Cognitive Disabilities (April 2007) .ovc.gov/
Martha Lamb, 2009 Justice Systems Innovations
FACTS ABOUT PROGRAMS DELIVERING BATTERED WOMEN'S SERVICES TO WOMEN WITH DISABILITIES
Questionnaires were mailed to 2,703 programs nationwide that deliver abuse-related services; 2200 came from the National Domestic Violence Hotline database of programs self-reporting wheelchair accessibility. We received 598 responses. Characteristics of Women with Disabilities Served by Abuse Programs •
The most common number of women with physical, mental or sensory disabilities served by a program during the past 12 months was 20, but the number served varied widely from one program to another, ranging from 0 to 12,000 women.
•
The disability type most likely to receive services from an abuse program was mental illness, whereas programs were the least likely to serve those with visual or hearing impairments. On average, 10% of the women served by each program had physical impairments, 7% had mental retardation or developmental disabilities, 21% had mental illness, 2% had visual impairment, and 3% had hearing impairment. For nearly half of the programs, less than 1% of their clients served within the past year had physical impairments.
Service Delivery •
Abuse programs on average provided two services targeted to women with disabilities; 89% of abuse programs provided less than five special services for women with disabilities.
•
The most commonly provided service available to women with disabilities was accessible shelter or referral to accessible safe house or hotel room (83%). A majority of abuse programs provided individual counseling (80%), and group counseling (73%). Nearly half (47%) provided an interpreter for hearing impaired women. Less than half (40%) presented workshops or other training on recognizing potentially violent situations. Approximately one-third offered safety plan information modified for use by women with disabilities (36%), and disability awareness training for program staff (35%).
•
The service least likely to be offered was personal care attendant services, available in only 6% of abuse programs.
•
Sixteen percent of programs have a program staff member who is specifically assigned to provide services to women with disabilities. Respondents identified one-quarter of these 79 staff members as being social workers by training, while the second most common primary field of training or expertise for this staff member was peer counseling (22%), meaning that the individual had personal experience with abuse or disability, then rehabilitation counseling (15%), and psychology (13%). Only a very few (less than 5 each) program staff for disability services were nurses, other types of mental health specialists, legal or paralegal specialists, sign language interpreters, substance abuse specialists, or community volunteers.
Outreach •
When participants were asked to describe the most effective outreach services for making women with disabilities aware of the abuse services offered by a program, 49% of respondents suggested community presentations and training, followed by printed materials (40%), then collaboration with agencies and advocacy groups that serve women with disabilities (26%), and direct service outreach and referrals (18%).
•
Although 49% of respondents considered presentations in the community focusing on the needs of abused women with disabilities to be the most effective outreach method, only 16% of programs offered it. Distributing printed materials was the second most frequent suggestion for outreach made by abuse programs, but only 13% had printed information targeted specifically to women with disabilities.
•
Abuse programs were also unlikely to educate law enforcement personnel about disability-related abuse; 12% of programs provided this service.
Conclusions •
Although women with mental illness are being served by battered women's programs, very few women with physical, visual, or hearing impairments are receiving services from these programs.
•
The majority of the programs that responded offer accessible emergency shelter, yet few women with physical disabilities call them to request services. Outreach in the form of presentations in the community and distribution of printed materials is needed to make women with disabilities aware of programs that can help them resolve abuse.
•
Battered women's programs need to collaborate with personal care attendant agencies and independent living centers to enable the provision of personal assistance services for women with severe physical disabilities at emergency
shelters. •
The sensitive handling of domestic violence and sexual assault against women with disabilities should be a mandatory part of the training of law enforcement personnel in every city. They need to be aware of the additional measures that may be needed to keep a woman with a disability safe from the perpetrator.
•
The proportion of battered women's programs that provide disability awareness training for their staff needs to rise from one-third to 100% of all programs.
•
Battered women's programs that did not return surveys and that do not provide services to women with disabilities should network with programs that do serve women with disabilities to discover how to finance and provide these services.
— CROWD — Study and Wellness — to Health Care — Abuse and Women Community Living — Materials — from Friends
Center for Research on Women with Disabilities 3440 Richmond Avenue, Suite B - Houston, Texas 77046 Phone: 713-960-0505 Toll Free: 800-44-CROWD Fax: 713-961-3555 email: @bcm.tmc.edu Department of Physical Medicine and Rehabilitation Baylor College of Medicine ----Last update: 1/6/2000 Copyright © 2000 Baylor College of Medicine
Additional items to take for persons with disabilities • • • • • • • • • •
Social Security card or Social Security award letter Proof of disability Adaptive equipment (wheelchair or other mobility device, shower bench, communication devices) Medical records Prescriptions, doctor’s orders Urological supplies Service animal and needed supplies for their care Names and phone numbers of home health agencies, caseworkers and other disability service providers to assist in coordinating services for you Phone number of personal care attendants / friends who might be willing to help with personal care tasks during the transition period Bus pass or other transportation documents
MODEL PROTOCOL ON SCREENING PRACTICES FOR DOMESTIC VIOLENCE VICTIMS WITH DISABILITIES
Revised 2004
Cathy Hoog, Abused Deaf Women’s Advocacy Services for the Washington State Coalition Against Domestic Violence
ACKNOWLEDGEMENTS The Washington State Coalition Against Domestic Violence is indebted to the author and project co-coordinator, Cathy Hoog, for her tireless efforts and extraordinary insights in creating this document. The Washington State Coalition Against Domestic Violence is appreciative of the critical thinking and goodwill of the members of the advisory committee who have given their time, expertise and support for this project. We would also like to thank the staff of the Washington State Coalition Against Domestic Violence and the staff of Disability Services ASAP (A Safety Awareness Program) of Safeplace in Austin, Texas for their support and expertise. Special thanks also to Christine Olah of WSCADV for formatting and editing this guide. Advisory Committee: Cathy Hoog, Disability Project Co-Coordinator and Community Advocacy Coordinator, Abused Deaf Women’s Advocacy Services Laura Law, Director of Housing Support Services and Advocate, YWCA Anita Vista Transitional Housing Program David Lord, Attorney, Washington Protection Advocacy Services Karen Mitterer, Private Attorney, Disability Advocacy Ginny Ware, Transitional Housing Program Manager, New Beginnings for Battered Women and their Children Leigh Nachman Hofheimer, Disability Project Co-Coordinator, Washington State Coalition Against Domestic Violence
This project was supported by funding from the Washington State Department of Social and Health Services, Children’s Administration, Division of Program and Policy. Points of view in this document are those of the author and do not necessarily represent the official position or policies of the Washington State Department of Social and Health Services. This project was supported by Grant No. 2002-FW-BX0006 awarded by the Violence Against Women Office, Office of Justice Programs, U. S. Department of Justice. Points of view in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice. Permission to reproduce any portion of this guide is granted, on the condition that the Washington State Coalition Against Domestic Violence and author Cathy Hoog are credited.
Model Protocol on Screening Practices for Domestic Violence Victims with Disabilities Introduction The goal of this protocol is to support domestic violence agencies in the State of Washington in examining and revising their intake and screening process to include questions about disability issues. Inquiring if a victim has a disability that requires accommodation gives the program information that enables them to provide appropriate accessible services. One in five women is limited in a major life activity by a disability, according to the US Census.1 Although conflicting information exists, current research leads us to believe that the incidence rate of domestic violence against women with disabilities is about the same as any other group of women, yet victims with disabilities are more likely to stay longer in an abusive situation, and have fewer options for safety due to systemic barriers and physical barriers in the community.2 A victim's disability may not be easily noticed or easily discussed. A victim may not be comfortable in disclosing information about a disability, and may have experienced negative reactions to past disclosures. Using a screening tool for disabilities with everyone affirms that your agency is aware of the issues facing victims with disabilities. This protocol seeks to strengthen advocates’ ability to identify the issues of power and control facing a victim with disabilities, by expanding screening questions to include common tactics of abuse against people with disabilities. These tactics include: manipulation of medication; financial exploitation; destruction of or withholding of assistive devices; neglect or refusal to help with personal care (such as toileting); emotional abuse that is specifically focused on a victim’s disability. Barriers for victims with disabilities created by both society and the perpetrator could convince a victim that escape is not possible. An advocate’s willingness to discuss how the perpetrator’s abuse impacted the victim’s disability can assist in removing identified barriers to the victim’s autonomy. 1
Americans with Disabilities: 1997, by Jack McNeil, U.S. Census Bureau, Current Population Reports P70-73, Washington, D.C., March 2001 (revised August 2002). 2 “Violence Against Women with Disabilities,” a white paper for the conference Preventing and Intervening with Violence Against Children and Adults with Disabilities, May 2002. Prepared by Margaret A Nosek, PH.D, Rosemary B Hughes, Ph.D, Heather B Taylor, Ph.D, and Carol Howland.
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Using appropriate screening practices helps your program realistically evaluate what a victim needs in order to access your services—regardless of their disability. Your program should be knowledgeable about the accessibility of services and be prepared with alternatives for providing services if a barrier exists. This process should never be used to “screen out” or deny services to a victim based on their disability. These screening practices may help you gather information that can be used in your planning process to improve the overall access of your program.3
3
To review additional information about enhancing program and agency accessibility, see Increasing Agency Accessibility For People With Disabilities, Domestic Violence Agency Self-Assessment Guide, Cathy Hoog for the Washington State Coalition Against Domestic Violence, Seattle, WA, January 2003, www.wscadv.org.
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Recommended Policy [Name of agency] shall work to ensure meaningful access for all recipients of services by developing and implementing comprehensive screening practices that: • Inform all victims that the agency understands the need for accommodation. • Encourage victims with disabilities to request accommodation(s). • Respect victims with disabilities as the experts in what they need to function while receiving domestic violence services. • Focus on the activities and services that will be provided and assist the advocate in determining the best ways to accommodate the victim.
The process for developing your agency’s screening protocol should include the following steps: •
Develop policies and procedures to identify possible accommodation needs by screening at the point of initial contact and again whenever the function of these services are added or changed.
•
Develop policies and procedures to allow for the provision of services even to those individuals who do not disclose a disability.
•
Review policies and procedures to identify those that might inadvertently make victims ineligible for services based on their disability, and change or remove such policies or procedures. Denying services based on an individual's disability is not legal unless there is no reasonable accommodation available.
•
Develop screening questions that identify accommodation needs and help an advocate determine what barriers the victim has experienced or fears she may have about using domestic violence services.
•
Develop screening questions that identify the victim’s strengths and her expertise in understanding how her disability affects her abuse experience. Develop screening questions that recognize the ways a victim’s disability may have affected her abuse experience and her daily life activities.
•
Develop screening questions that identify the physical environment of the abusive situation and the relationship of the abuser. For example, is the
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victim living in a group home institution or private home? Is the perpetrator a personal care attendant or possibly a guardian of the victim? •
Develop screening questions that assist an advocate in determining what resources are available to the victim because of her disability, and if the victim has any concerns about that support system's possible alignment with the abuser or inability to maintain confidentiality.
•
Develop screening practices that maintain a victim’s autonomy and privacy, keeping confidentiality in mind at all times. Lack of privacy and confidentiality is often a crucial piece of the abuse dynamic for a victim with a disability.
•
Develop screening practices that include preparation in advance of alternate formats of materials that are used during the screening process.
•
Develop a budget plan to implement the screening practices and accommodations at all levels of service.
•
Provide periodic staff training on how to implement the screening protocol.
•
Periodically monitor implementation of the screening protocol.
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Recommended Procedures Initial Contact and Crisis Intervention Identify and use appropriate language for screening that recognizes personal caregivers, or other specialized support personnel, as potential abusers and accepts them under your program’s definition of "intimate partner" or “abuser.” Until you know the relationship of the abuser to the victim, avoid words like “husband” or “boyfriend” that predetermine the gender and role of the abuser in the victim’s life. If the victim has a disability, determine how your program can best deliver services and avoid making assumptions about what accommodation each particular victim would prefer. There are a wide variety of people with disabilities—each with their own individual preferences and varied needs. What works for one person might not be acceptable for the next person you serve, even if they have the same disability. Ensure that advocates have knowledge and training to identify how power and control issues may differ depending on the victim’s disability, or a perpetrator’s disability, or a child's disability, or even another family member's disability. Ensure that discussions about a person’s disability take place in a private setting, preferably one-on-one. If a third party is present to accommodate the needs of the victim (perhaps as a caregiver), advocates should try at the soonest possible time to be alone with the victim long enough to ask her if she feels comfortable talking with the third party present. Accept the challenge of taking more time and using a variety of communication techniques that allow for the clearest discussion possible. In a crisis situation, time is often limited, but proceeding with incorrect information could be more costly than taking the time to communicate accurately. Avoid a patronizing attitude, always treating adults like adults regardless of their communication needs or comprehension skills. Document accommodation requests and share information among appropriate staff (e.g., between shift changes) to ensure that the requested accommodation is provided for the entire period that the victim is using your services. Victims should not be made to request the same accommodation to each new staff person providing service. As service needs change, additional discussion with the victim may be needed. Think about the normal flow of services for a victim and try to identify areas where service delivery may need to be altered. For example, Model Protocol on Screening Practices for Domestic Violence Victims with Disabilities Washington State Coalition Against Domestic Violence
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if the shelter residents usually participate in a support group off-site after their shelter stay, the accommodations you provide for group might be very different from those provided at the shelter facility. Have the forms you use available in alternate formats, such as having intake forms available in large print, on computer disk and on audiotape. Additionally, maintain a list of interpreters (for example, American Sign Language and DeafBlind) willing to come to your facility when needed.
Ongoing Provision of Domestic Violence Services Persons with disabilities vary significantly in their comfort level for disclosing information about their disability. Just like other victims, they may be afraid that disclosing information to you will prevent them from getting help. A victim may grow comfortable enough to request accommodation only after building trust. Plan for some flexibility to allow the victim to make a request for accommodation at any time during her participation in your program. If a staff person becomes aware of a possible disability issue during service delivery, they should ask the victim how they prefer to handle the situation and then determine what accommodation can be offered. Questions about a victim’s disability should relate directly to advocacy and service provision. Focus on providing or advocating for appropriate services that fit the individual’s needs and life experiences. What to ask and at what point is an ongoing, dynamic process. Advocates should be thoughtful when providing general referral information to victims and always consider the accessibility of the referral agency. For example, if a victim who uses a wheelchair needs resource information on food banks, an advocate should call the food bank to determine which locations are accessible before giving the referral information to the victim. When making referrals, advocates should ask victims about their disability to help determine appropriate potential resources such as funding for emergency caregivers or necessary technology for independence.
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APPENDIX Sample Screening Questions Is there anything I need to know about you to be able to provide the best services possible? Does anyone control your communication with others or change what you are trying to say? Has anyone taken or broken something that you need to be independent? For example, your cane, walker, wheelchair, respirator or TTY? Does anyone have legal control over your money or your decisions? What happens if you disagree with them about their decisions? Does anyone prevent you from using resources and support you need to be independent? For example, resources such as vocational services, personal care attendants, disability agency support person, specialized support personnel for Deaf-Blind, readers or interpreters? Has anyone refused to give you your medication, kept you from taking your medication or given you too much or too little medication?4 Do you have any health issues that can become dangerous if neglected, such as diabetes, epilepsy, skin sores, cancer or heart disease?5 If you depend on caregivers, does your caregiver use your need for assistance to keep control over you? Do you have emergency back-up caregivers?6
4
M.A. Curry, DNSC, Development of An Abuse Screening Tool for Women with Disabilities, Oregon University School of Nursing, Portland, OR, 2002. 5 Ibid. 6 Ibid.
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Signing Documents When Physically Unable © 2003 Northwest Justice Project
Introduction Sometimes a person wants to sign a document such as a power of attorney, will or deed, but is physically unable to write her/his name. As long as the person is mentally competent to understand what she/he is signing, the fact that she/he cannot actually sign does not prevent the person from executing the document as long as the following procedures are followed. The laws discussed in this publication are attached at the end of the information for your reference.
Using a Notary Public The Revised Code of Washington, RCW 42.44.080(2), and RCW 64.08.100 authorizes a notary to sign on behalf of a disabled person who is unable to sign a document under the following conditions: 1. The notary must have satisfactory evidence that the person is physically unable to sign her name and is otherwise mentally competent. 2. The notary's statement should state that the signature was obtained under the provision of RCW 64.08.100. 3. The person appearing before a notary must orally direct (tell) the notary to sign the person's name on her/his behalf. IMPORTANT: If a physical impairment has affected the quality of penmanship, but the person can still sign with a mark that she considers to be her/his signature, no notary is required. The mark considered to be one's signature is legally sufficient, no matter how inelegant its appearance. It may be a good idea, however, to have a mark notarized or witnessed if it is difficult to read in case an argument arises about whether or not the disabled person really signed.
Signing A Will There is a specific statute dealing with how to sign a will when an individual is unable to sign. This statute is RCW 11.12.030. Suppose that May Jones is mentally competent but paralyzed by a stroke. May can tell her friend, Sue Smith, to sign May's name on her will. Sue Smith would sign May Jones' name and then her own name and state that she signed May Jones' name at May's request. (The will would look like this: "May Jones, signed by Sue Smith at May Jones' request.")
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Or, May could just make a mark, such as an "X," on the signature line, and it would be considered the same as an actual signature. The requirement that the signing of a will be witnessed by two people would still apply when the will is being signed by a mark or at the direction of a person unable to sign.
If the Person Signing is Incompetent A person is considered competent until a court rules that she or he is not. However, if a person is actually not able to understand what she is signing, or the consequences of signing, the signature may later be declared to be invalid. To avoid this result, the document should be signed, when possible, by the legal guardian or by someone with a valid, durable power of attorney. If there is no guardian or durable power of attorney, it may be necessary to file a court action to declare the person incompetent and appoint a guardian to sign documents for them. It is a good idea for all adults to give someone trustworthy a durable power of attorney to prevent the need for court proceedings. Northwest Justice Project has a do-it-yourself packet with the forms and instructions needed to sign a power of attorney. See our publication About Powers of Attorney [available at http://www.nwjustice.org/law_center/index.html]. Like any other document, the person signing a power of attorney must understand what she is signing for the document to be valid.
The Laws RCW 64.08.100 - Acknowledgments by persons unable to sign name Any person who is otherwise competent but is physically unable to sign his or her name or make a mark may make an acknowledgment authorized under this chapter by orally directing the notary public or other authorized officer taking the acknowledgment to sign the person's name on his or her behalf. In taking an acknowledgment under this section, the notary public or other authorized officer shall, in addition to stating his or her name and place of residence state that the signature in the acknowledgment was obtained under the authority of this section. Enacted by Laws 1987, ch. 76, þ2. RCW 42.44.080 - Standards for notarial acts A notary public is authorized to perform notarial acts in this state. Notarial acts shall be performed in accordance with the following, as applicable: 1. In taking an acknowledgment, a notary public must determine and certify, either from personal knowledge or from satisfactory evidence, that the person appearing before the notary public and making the acknowledgment is the person whose true signature is on the document. Model Protocol on Screening Practices for Domestic Violence Victims with Disabilities Washington State Coalition Against Domestic Violence
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2. In taking an acknowledgment authorized by RCW 64.08.100 from a person physically unable to sign his or her name or make a mark, a notary public shall, in addition to other requirements for taking an acknowledgment, determine and certify from personal knowledge or satisfactory evidence that the person appearing before the notary public is physically unable to sign his or her name or make a mark and is otherwise competent. The notary public shall include in the acknowledgment a statement that the signature in the acknowledgment was obtained under the authority of RCW 64.08.100. 3. In taking a verification upon oath or affirmation, a notary public must determine, either from personal knowledge or from satisfactory evidence, that the person appearing before the notary public and making the verification is the person whose true signature is on the statement verified. 4. In witnessing or attesting a signature, a notary public must determine, either from personal knowledge or from satisfactory evidence, that the signature is that of the person appearing before the notary public and named in the document. 5. In certifying or attesting a copy of a document or other item, a notary public must determine that the proffered copy is a full, true, and accurate transcription or reproduction of that which was copied. RCW 11.12.030 - Signature of testator at his or her direction - Signature by mark Every person who shall sign the testator's or testatrix's name to any will by his or her direction shall subscribe his or her own name to such will and state that he or she subscribed the testator's name at his request: Provided, that such signing and statement shall not be required if the testator shall evidence the approval of the signature so made at his or her request by making his or her mark on the will. Enacted by Law 1965, ch. 145, þ 11.12.030, eff. July 1, 1967. © 2003 Northwest Justice Project, 1-888-201-1014, TDD 1-888-201-9737, www.nwjustice.org. Permission for copying and distribution granted to Washington State Access to Justice Network and individuals for non-commercial use only. This publication provides general information concerning your rights and responsibilities. It is not intended as a substitute for specific legal advice. This information is current as of the date of its printing, July 2001.
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Basic Disability Awareness: Providing Disability-Friendly Sexual and Domestic Violence Services
Training Manual
Developed by the North Carolina Basic Awareness: OfficeDisability on Disability and Health
Providing Disability-Friendly Sexual and Domestic Violence Services
1
1
Basic Disability Awareness: Providing Disability-Friendly Sexual and Domestic Violence Services
Training Manual 2006
Suggested Citation: North Carolina Office on Disability and Health (2006). Basic Disability Awareness: Providing Disability-Friendly Sexual and Domestic Violence Services. The University of North Carolina - Chapel Hill, FPG Child Development Institute, NCODH.
Additional copies: Order copies from the NCODH website at http://www.fpg.unc.edu/~ncodh. Whenever possible, NCODH will make publications available in alternate formats, such as large print, audio, diskette, upon request. This curriculum was printed at a cost of 1,577.08 or $0.72 per copy.
1
TABLE OF CONTENTS Introduction
2-4
Module 1: What is Disability?
5
Overview
6-7
ACTIVITY 1: Overview of Disability
8-17
ACTIVITY 2: Messages about Disability
18-19
ACTIVITY 3: At Risk
20-30
Module 2: Disability-Friendly Services
31
Overview
32-33
ACTIVITY 1: Interacting with People with Different Types of Disabilities
34-48
ACTIVITY 2: Role-Plays
49-56
ACTIVITY 3: Resources for Clients with Disabilities
57-67
ACTIVITY 4: “Credo for Support” video
68-70
Module 3: All About Access
71
Overview
72-73
ACTIVITY 1: Is Your Agency Accessible?
74-97
ACTIVITY 2: Accessible Print Materials
98-104
ACTIVITY 3: Where Do We Go from Here?
105
Credits
106
1
INTRODUCTION An estimated 18% of women in the U.S., ages 21-64 years, live with some type of disability (U.S. Census, 2000). Women with disabilities experience an alarmingly high incidence of violence and abuse. •
Sixty-two percent of a national sample of women with physical disabilities reported having experienced emotional, physical, or sexual abuse (Nosek, M. & Howland, C., 1998).
•
Adults with developmental disabilities experience physical or sexual assault at a rate 4-10 times higher than adults without developmental disabilities (Office of Victims of Crime Bulletin, 1998).
•
Women with disabilities were significantly more likely to experience emotional and sexual abuse by personal care attendants and health care workers than women without disabilities (Nosek et al., 1995).
•
Persons with disabilities in North Carolina experience sexual assault at a rate five times higher than persons without disabilities (BRFSS, 2000-2001).
Women with disabilities face unique issues that may place them at increased risk for violence, and they may experience numerous barriers in accessing services (Sobsey & Mansell, 1994). For example, people with disabilities may need accessible transportation, a TTY, sign language interpreters, a ramp, or alternate formats of written materials to address their needs. In 2001, the Violence Working Group of the Injury Prevention Research Center at the University of North Carolina in Chapel Hill conducted the North Carolina Domestic Violence Programs Survey. This needs assessment gathered information from domestic violence programs in North Carolina regarding their current services and perceptions about gaps in services. In particular, there was interest in the provision of services to specific populations, including individuals with disabilities. Seventy-one domestic violence shelters in North Carolina (65% of which also provided sexual assault services) completed surveys regarding their services to people with disabilities. Many programs reported that they were only “somewhat able” to meet the needs of clients with disabilities and that they would benefit from additional training. Staff identified gaps such as insufficient training, too few staff, lack of equipment, and inability to make structural changes to improve physical accessibility. Staff recommended training on the following topics: Shelter-specific strategies on working with individuals with disabilities Education about disabilities Ways to improve shelter accessibility Guidance from model programs on establishing better community networking Information on alternative funding sources 2
In response to the needs identified in the survey, we have developed this curriculum to assist domestic and sexual violence service providers to enhance their services to people with disabilities. THE GOALS OF THIS CURRICULUM: 1. Increase knowledge and sensitivity about disability. 2. Share strategies on working effectively with people with disabilities. 3. Provide tools to assess accessibility of service environments 4. Provide strategies to improve accessibility and outreach for people with disabilities. THE CURRICULUM IS DIVIDED INTO 3 TWO-HOUR TRAINING MODULES: 1.) What is Disability? 2.) Disability-Friendly Services 3.) All About Access We encourage you to train all staff, volunteers, and board members using all three modules. Policy makers, including administrators and board members, may find Module 3 especially useful. Although we encourage you to use all three modules in your overall training effort, each module can be used as a stand-alone unit. The trainer notes for each session include: • Time needed to complete activity • Session objectives • Background information • Materials and preparation suggestions • Steps to complete the activities • Handouts RECOMMENDATIONS FOR TRAINERS: • Have at least two trainers. We strongly encourage domestic and sexual violence agency trainers to partner with a person with a disability to co-train; the lived experience of a person with a disability is an invaluable resource. • Before beginning training, read the entire curriculum and accompanying handouts to begin to understand disability, the Americans with Disabilities Act, and state and local resources. • For each 2-hour module, include a 10 or 15 minute break. When to schedule the break is left to the discretion of the trainer. Check in with participants to gauge their level of comprehension or need for a break. • Make sure the training site is accessible for all participants and trainers. • Inquire about any accommodations participants may need. • Offer training materials in alternate formats (large print, etc.), if needed. 3
•
Adapt training activities as needed for participants or trainers who may have disabilities.
REFERENCES Injury Prevention Research Center (2002, August). NC domestic violence programs survey. A description of service provision focused on meeting the needs of special populations. Nosek MA, Rintala DH, Young ME, Howland CA, Foley CC, Rossi CD, & Chanpong G. (1995). Sexual functioning among women with physical disabilities. Archives of Physical Medicine and Rehabilitation; 77(2): 107-115. Nosek, M.A., Howland, C.A., & Young, M.E. (1998). Abuse of Women with Disabilities: Policy Implications. Journal of Disability Policy Studies 8 (1,2), 158-175. Office of Victims of Crime Bulletin. (1998, September). Working with Victims of Crime with Disabilities. Ontario Ministry of Community and Social Services. (1987). Disabled women more likely to be battered, survey suggests. The Toronto Star, April 1, F9. Sobsey D, Mansell, S. (1994). An international perspective on patterns of sexual assault and abuse of persons with disabilities. International Journal of Adolescent Medicine & Health, 7: 153-178. State Center for Health Statistics. (2001). BRFSS. Health Risks Among North Carolina Adults: 1999, with a Special Section on Persons with Disabilities. U.S. Census Bureau. U.S. Census 2000 Summary File 3 www.census.gov/main/www/cen2000.html
4
MODULE 1 WHAT IS DISABILITY?
INTRODUCTION AND OVERVIEW ACTIVITY 1: Overview of Disability ACTIVITY 2: Messages about Disability ACTIVITY 3: At Risk
5
MODULE 1 WHAT IS DISABILITY? INTRODUCTION AND OVERVIEW TIME: 5 minutes BACKGROUND: Take a few minutes to set the stage for training. This introduction and overview provides the opportunity to state the goal of the training, give an overview of the content, explain the roles of the facilitators and participants, and agree on group guidelines. OBJECTIVES: At the end of this activity, participants will have: 1. Understood the goal of training and reviewed the agenda. 2. Understood their roles and the role of the facilitator(s). 3. Agreed on group guidelines. MATERIALS: • Flip chart • Marker STEPS: 1. Welcome participants and give an overview of the training. You may want to write down the Goal and the Agenda and post them in the room. •
Goal: The goal of our training session is to increase disability knowledge and awareness among staff and volunteers at sexual and domestic violence service agencies.
•
Overview / Agenda: Our agenda for this session includes the following activities: o “Overview of Disability” in which we will define disability, discuss types of disabilities and become familiar with disability data and prevalence. o “ Messages About Disability” in which we will explore some of the societal attitudes and stereotypes about people with disabilities; and o “At Risk” in which we will identify some risk factors and vulnerabilities for violence that are unique to persons with disabilities.
•
Roles: This room is full of people with a wealth of ideas and experiences. We want you to share your ideas. Your role is to participate actively during training. The role of the facilitator is to guide discussion and emphasize important takehome messages. 6
•
Guidelines: Let’s look at these sample Group Guidelines. Does anyone want to add to this list? Does everyone agree to follow these guidelines during our training time together? Group Guidelines • Start and end on time. • Respect others’ opinions. • Ask for clarification. • Create a safe place for expression. • Share your own experiences. • Maintain confidentiality. • Members participate in all phases of the process as they choose.
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ACTIVITY 1 OVERVIEW OF DISABILITY TIME: 40 minutes BACKGROUND: This activity provides an overview of disability and an opportunity for participants to gain awareness that people with disabilities are particularly vulnerable to experiencing domestic and sexual violence. OBJECTIVES: At the end of this activity, participants will have: 1. Learned the definition of disability and general types of disabilities. 2. Become familiar with disability and violence prevalence and statistics. MATERIALS: • Flip chart paper • Marker • Pencils • Handouts o What is Disability? o The Americans with Disabilities Act o Defining Disability o Disability and Violence Statistics quiz o Disability and Violence Statistics quiz key STEPS: 1. Distribute handouts. Review the definition of disability using the handouts “What is Disability?” and “The Americans with Disabilities Act”. Also discuss the following definitions: •
Disability - A physical or mental condition that substantially limits one or more major life activity, a record of such a condition, or being regarded as having such condition. (ADA definition)
•
Disabled - Not able to work. For example – 1) The morning traffic report says that a disabled vehicle is in the right lane of traffic. 2) The flight attendant says that federal law prohibits tampering with, disabling or destroying the smoke detectors in airplane lavatories. 3) The Social Security Administration defines disabled as “not able to be gainfully employed”. One can have a disability and not qualify for a ‘disability check’ under SSI because the person is able to work.
•
Handicap - A physical or social barrier that puts people with disabilities at a disadvantage and hinders their ability to fully participate in society; a handicap can be removed. This is often used incorrectly, for example, “handicapped parking” is really “accessible parking” – the parking without the barriers. 8
2. Ahead of time, record the following types of disabilities on a flipchart. Review with participants and briefly give examples of each type. Invite discussion and experiences of participants. TYPES OF DISABILITIES There are hundreds of types of disabilities. Although this is not a complete list, there are some groupings that may help participants think about the diversity of disabilities: • Deaf and hard of hearing o May affect ability to hear or process sound • Low vision and blindness o Usually some level of sight is present • Cognitive disabilities (e.g., traumatic brain injury, intellectual disability [sometimes called mental retardation], Alzheimer’s) o Are often not visible disabilities o Can affect a person’s ability to receive, process, and recall information • Mobility disabilities (e.g., spinal cord injury, muscular dystrophy, amputation) o Can affect coordination and/or use of muscles o Often visible, but not always • Mental health disabilities (e.g., depression, bi-polar disorder) o Are usually not visible disabilities o Can affect how a person receives, processes and recalls information • Speech/language disabilities (e.g., stroke, cerebral palsy) o May not be visible o Can affect a person’s ability to communicate information ADDITIONAL POINTS TO MAKE ABOUT DISABILITY: • Disability may be temporary or permanent, and may range from a short-term experience of post-traumatic stress or a broken leg to long-term experience of arthritis or a spinal cord injury. Disability may be episodic, as with epilepsy, or controlled, as with diabetes. It may be experienced as part of the aging process when eyesight, stamina, or physical/mental dexterity can diminish. • Disability affects people of every culture, age, economic level, social background, and geographic location. • Disability affects most people at some time during their lifespan. • Disability is a universal experience. • Many people with disabilities and/or chronic conditions do not self-identify as having a disability. • How disability is perceived can have positive or negative impacts on life experience(s) and opportunities, including domestic and sexual violence services. For example, some think that people with cognitive disabilities do not need prevention programs because “they won’t understand anyway.” 3. Next, review the handout titled “Defining Disability”, which includes disability data reported by the U.S. Census and the North Carolina BRFSS (Behavioral Risk Factor Surveillance System – a telephone survey conducted each year in each state of the US). Both the US Census and the BRFSS survey have screener questions that identify people with disabilities. 9
•
Talk about the prevalence rates of disability in the US and NC and disability by minority groups. Note that disability occurs in about 1 in 5 persons and is prevalent among all minority groups, being more prevalent among certain groups. Thus, as a service provider tries to develop a culturally sensitive program, she/he may need to address a variety of cultural issues; for example, a client may be Latino and have a disability.
4. Ask, “What do we already know about persons with disabilities experiencing sexual or domestic violence?” • To begin the discussion, first administer the “Disability and Violence Statistics quiz”. Have participants complete the quiz. Acknowledge that these are some statistics based on specific studies done in the US. • Then read each statement aloud and have participants raise their hand if they think it is true or false. Get feedback from participants about their response to each statistic. Were they surprised? • Refer to the answer key, with study references, which is also included in the handouts. 5. Conclude activity with acknowledgement that violence among persons with disabilities is prevalent and often unrecognized. The remainder of our training time will be exploring how you as a service provider can better recognize persons with disabilities in your community who may have experienced violence, and learn ways to provide disability-friendly, accessible services to these clients.
10
W
What is Disability? A disability can be a physical, mental health, cognitive, or sensory condition that limits: 9 9 9 9 9 9 9 9
Walking Thinking Seeing Bathing Talking Hearing Mobility Everyday Activities
Additional Facts: 9 Disability affects all ages, races, economic levels, and social backgrounds. 9 There are hundreds of disabilities. 9 Some are present at birth. 9 Some come later in life and may be part of the aging process. 9 Some are visible. Some may not be obvious. 9 Many people with disabilities do not self-identify as having a disability. Disability can affect if and how an individual receives sexual assault and domestic violence services. 11
THE AMERICANS WITH DISABILITIES ACT The Americans with Disabilities Act was passed in 1990 as the nation’s first comprehensive civil rights law for people with disabilities. The ADA aims to eliminate discrimination by ensuring equal opportunity in employment, state/local government services and programs, places of public accommodation, transportation, and telecommunications. The goal of the Americans with Disabilities Act is to break down barriers that prevent people with disabilities from living independently and achieving economic self-sufficiency. Like other minority populations, people with disabilities have been marginalized, stigmatized and often isolated from the general public (limited access to education, employment, housing … viewed as sick, contagious, less than human … institutionalized in hospitals, nursing homes, and prisons). Like other civil rights legislation, the ADA seeks to advance the rights of people with disabilities and the opportunity to participate in activities, programs, and services experienced by people without disabilities. The ADA guarantees people with disabilities “equal opportunity” to participate in, and benefit from, services and programs. People with disabilities may already be limited in their ability to achieve independence and economic self-sufficiency because of physical, architectural, communication and attitudinal barriers. Thus, it is critical that domestic violence/sexual assault agencies embrace the ADA as a central feature of their mission to provide services to all people. Who is covered by the ADA? The ADA first and foremost covers persons with disabilities. ADA defines persons with disabilities as those who: • Have a physical or mental disability that substantially limits one or more major life activity, such as performing manual tasks, self-care, walking, seeing, hearing or working; • Have a record of such a disability; or • Are regarded as having such a disability. Examples • A person with arthritis who is unable to perform manual tasks such as bathing or dressing is covered under the ADA. • A person with a history of cancer is covered under the ADA and cannot be discriminated against based on his or her record of having been treated for cancer. • A person who has facial disfigurement resulting from burns who is denied employment for fear that customers may be uncomfortable also is protected by the ADA.
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ADA Resources ADA Technical Assistance Program This network of regional ADA technical assistance centers, sometimes called Disability Business Technical Assistance Centers (DBTACs), is a comprehensive resource for information, materials, technical assistance, and training on the ADA. These centers are well suited to providing health organizations with assistance in making programs accessible and compliant with ADA. Information is provided regarding topic areas such as ADA information (such as Title I, II, III, IV, and V regulations) and is available in manuals, videos, and publications in multiple languages. The website and toll free number below provide information, an extensive list of publications, and a means to connect to your regional center. ADA Technical Assistance Program 800-949-4232 (V/TTY) http://www.adata.org/dbtac.html
The Access Board This federal agency provides technical assistance, training, and research on accessible design. The Access Board develops and disseminates Accessibility Guidelines and Standards, which are minimum guidelines for standards under the ADA. Publications on communication aids are also available. The Access Board 1331 F Street, NW, Suite 1000 Washington, DC 2004-1111 202-272-0080 (V) or 202-272-0082 (TTY) 800-872-2253 (V) or 800-993-2822 (TTY) http://www.access-board.gov
United States Department of Justice The Disability Rights Section of the DOJ carries out the mandates of the ADA through regulatory, mediation, and technical assistance activities. Publications are available on the DOJ website or can be ordered through the ADA Information Line. Public Access Section, Civil Rights Division US Department of Justice P.O. Box 66738 950 Pennsylvania Avenue, NW Washington, DC 20035-9998 ADA Information Line: 800-514-0301 (V) or 800-514-0382 (TTY) http://www.usdoj.gov/disabilities.htm 13
DEFINING DISABILITY Definitions of disability have been driven by government agencies to determine eligibility for benefits and services. As a result, disability has been measured in different ways across surveys and censuses, leading to conflicting estimates of the prevalence of disability. Increasingly, surveys are basing the definition of disability on limitations in daily activities such as working at a job, using a phone, self-care such as eating, bathing, and toileting, or going outside the home alone. A person is considered to have a disability if he/she needs help to perform the activity, uses assistive equipment, or requires standby help. Furthermore, these limitations are expected to be permanent or long term (chronic) in duration. Using a definition of disability based on limitations in activity results in a broad definition of disabilities including some disabilities present from birth (ie. cerebral palsy, spina bifida, intellectual disability) and others coming later in life as a consequence of injury, chronic disease, or aging (ie. spinal cord injury, arthritis, traumatic brain injury, Alzheimer’s disease). PREVALENCE OF DISABILITY According to the 2000 U.S. Census, an estimated 19.3% (totaling 54 million people) of non-institutionalized civilians, ages 5 and older have a disability. Also, the Census estimated 25% of adults, 21 years and older, have a disability. Another source of population-based prevalence of disability and functional activity limitation is through the Behavioral Risk Factor Surveillance System (BRFSS). According to the 2001 North Carolina BRFSS, 25.3% of adults, ages 18 and older, were living with some type of disability. Despite differing methods of identification of disability used by the U.S. Census and the BRFSS, disability prevalence estimates are comparable (25% for adults 21 and older in the 2000 Census and 25.3% for adults 18 and older for the NC BRFSS). Almost one in five people has a disability Americans with Disability, Ages 5+
19.30%
With Disability Without Disability
80.70%
Source: U.S. Census Bureau, Census 2000 14
Data estimate as derived from the U.S. Census and the BRFSS indicate that across the life span, a substantial number of persons are living with some type of disability. The occurrence of disability increases among middle-aged adults and continues to increase among the elderly population. Moreover, the number of persons with disabilities will likely increase as our population ages, medical care and technology improve, and “institutionalized” individuals transition into the community from hospitals and nursing homes. This emerging population will require domestic violence and sexual assault agencies to have the capacity to provide inclusive, accessible services.
DISABILITY AMONG ETHNIC GROUPS Data also shows that people with disabilities are present in all ethnic groups. The U.S. Census 2000 prevalence rates, in the chart below, clearly indicate that people with disabilities are prevalent within other minority groups. Domestic violence and sexual assault organizations must recognize this issue when targeting services toward minority groups, such as African Americans or Latinos. Gaps often already exist in providing services to ethnic minority populations. It is critical to address disability issues in order to truly provide inclusive services and capture a large percentage of the target population that might have otherwise been overlooked. Remember not to assume that another organization is taking care of this need.
DISABILITY BY RACE / ETHNIC GROUP 30.00% 25.00% 20.00% Series1
15.00% 10.00% 5.00%
er
n ifi c
Is
la nd
As ia Pa c
ni c H
is pa
te W hi
In er ic an
Am
Af ric an
Am er ic
an
di an
0.00%
Source: U.S. Census Bureau, Census 2000
15
DISABILITY AND VIOLENCE STATISTICS QUIZ Circle true (T) or false (F) 1. Persons with disabilities in North Carolina experience sexual assault at a rate 2 times higher than persons without disabilities. T F
2. 62% of a national sample of women with physical disabilities reported having experienced emotional, physical, or sexual abuse. T F
3. Women with disabilities were significantly more likely to experience emotional and sexual abuse by personal care attendants and health care workers. T F
4. Adults with developmental disabilities have 2-8x greater risk of physical/sexual assault. T F
5. As many as 26% of adults with cognitive disabilities are victims / survivors of sexual violence. T F
6. 50% of women with disabilities have experienced domestic violence.
T
F
7. Estimates that only 10% of sexual abuse cases involved people with developmental disabilities will ever be reported and such non-disclosure promotes an environment ripe for continued victimization. T F
8. Anecdotal evidence suggests sexual abuse crimes are seriously underreported; but when reported, victims are believed and cases are prosecuted. T F
16
DISABILITY AND VIOLENCE STATISTICS QUIZ KEY 1. Persons with disabilities in North Carolina experience sexual assault at a rate 5
times higher than persons without disabilities (BRFSS, 2000-2001).
2. 62% of a national sample of women with physical disabilities reported having
experienced emotional, physical, or sexual abuse (Nosek, M. & Howland, C., 1998).
3. Women with disabilities were significantly more likely to experience emotional
and sexual abuse by personal care attendants and health care workers (Nosek et al., 1995).
4. Adults with developmental disabilities have 4-10x risk of physical/sexual assault
(Office of Victims of Crime Bulletin, 1998).
5. As many as 76% of adults with cognitive disabilities are victims/survivors of
sexual violence (CDC, National Center for Injury Prevention and Control, 1996).
6. About 85% of women with disabilities have experienced domestic violence
(Feuerstein, 1997).
7. Estimates that only 3% of sexual abuse cases involved people with
developmental disabilities will ever be reported and such non-disclosure promotes an environment ripe for continued victimization (Reynolds, 1997).
8. Anecdotal evidence suggests sexual abuse crimes are seriously underreported;
when reported, victims not believed and cases not prosecuted (Sorensen, 1997; Sanders et al., 1997).
17
ACTIVITY 2 MESSAGES ABOUT DISABILITY TIME: 30 minutes BACKGROUND: This activity explores messages that participants have received about disability, where such messages come from, and how these messages may affect people with disabilities and/or service providers in a positive or negative way. The activity provides a good trigger for evaluative discussion about people’s attitudes and stereotypes. By recognizing that disability is as much a social phenomenon as it is physical and psychological, domestic and sexual violence agencies can develop and deliver programs and services that are appropriate to people with disabilities as well as the greater community. OBJECTIVES: At the end of this activity, participants will have: 1. Reflected on messages they have received from family, friends, the media, books, etc. regarding what it’s like to have a disability and what “people with disabilities” are like. 2. Recognized societal attitudes and stereotypes about people with disabilities. 3. Explored ways that perceptions of disability may impact services. MATERIALS: • Flip chart paper • Pieces of scrap paper • Pencils STEPS: 1. Introduce the activity. Pass out scrap paper and a pencil to each participant. • Spend a moment or two thinking about messages you have heard, read, seen in your life about persons with disabilities. o What are persons with disabilities like? o What’s it like to be a person with a disability? You don’t have to believe these messages; but we want to hear what messages you have received over the years. • Write down 1 message on the scrap paper; it can be a positive or negative message. • After everyone has written a message, crunch your sheet of paper into a ball and toss your message toward the opposite side of the room. • When the tossing has stopped, everyone should go pick up one ball of scrap paper, open it, and read the message on it. • Take turns reading the message you retrieved aloud to the group. Variation: Participants could fold their sheet of paper in half and exchange the paper with other participants several times before reading the message aloud to the group. 18
2. Respond to each message as it is read, inviting discussion and ideas from the group. Questions to prompt discussion include: • Were you surprised by the messages you retrieved, or did they sound familiar to you? • Where did we get these messages originally? Whose voice told us these things? • Do you think the messages are true or not true? • Which messages would you consider stereotypes? Realities? • Were there more positive or negative messages? • How might these messages impact: • People with disabilities? • Domestic or sexual violence service providers? • Services to domestic or sexual violence survivors? POINTS TO ADDRESS: • Recognize that we may initially come to these stereotypes without intention to harm. We hear and see them all around us. • Stereotypes are often based on behaviors exhibited by some members of a group; they are usually exaggerated and then generalized to all people from that group. • Images and stereotypes describing persons with disabilities as weak, dependent, stupid, wild, innocent, or asexual have often occurred in American culture throughout history. A person with a disability is often seen as either an object of pity or a source of inspiration. These images are internalized by people with and without disabilities and they build social stereotypes, create artificial limitations, and can contribute to the discrimination and minority status of persons with disabilities. • Some common myths and stereotypes include: • Spread – assuming a person with one disability has another; for example, a person with cerebral palsy has an intellectual disability (sometimes referred to as mental retardation) • Deviancy and evil – assuming anyone who is different is evil • Contagion – assuming those without disabilities can catch a disability • Innocence – assuming people with disabilities are asexual and child-like • Wildness – assuming people with disabilities are like wild animals and need to be separated from those without disabilities • Stupidity – assuming people with cognitive disabilities do not feel things in the same way; therefore, why offer them counseling? • Pity/Courage – discourages authentic interaction by over-reacting with awe at a person with a disability and their normal life activities; this minimizes and diminishes by assuming a person with a disability is less reliable and less competent. 3. With the group, identify some stereotypes about persons with disabilities that were discussed. Record these stereotypes on the flip chart. Adapted from: Planned Parenthood Of Connecticut, Inc. http://www.ppct.org/education/toolbox/mixedmsg.shtml
19
ACTIVITY 3 AT RISK TIME: 45 minutes BACKGROUND: This activity explores the risk factors and vulnerabilities for violence that people with disabilities may experience. Through scenarios about violence against people with disabilities, participants begin to appreciate some of the unique factors regarding disability that perpetrators of violence may take advantage of and how violence may be experienced in ways that are similar and different compared with persons without disabilities. OBJECTIVES: At the end of the activity, participants will have: 1. Identified vulnerabilities for violence for people with disabilities. 2. Listed specific ways that violence is experienced differently for persons with disabilities. 3. Identified how power was used inappropriately. Materials: • Flip chart paper • Scenario highlights on flip chart papers • Markers • Handouts o At Risk Scenarios o Red Flags for an Abusive or Potentially Abusive Caregiver o Risk Factors for violence for Many People with Disabilities o Disabilities- Specific Types of Abuse Experienced by People with Disabilities • Video, “End the Silence” • VCR / TV STEPS: 1. Introduce the activity. • In this activity we will read and evaluate five scenarios. In each scenario a person with a disability experiences violence. • We will divide into five groups, each group taking one scenario. (See “Note to Trainer” below.) • Pay particular attention to how the individual with a disability experiences violence and how the violence occurs in the story. 2. Divide participants into five groups. 3. Give each group a copy of one scenario so that all five scenarios are distributed among the groups. Explain that there are 3 discussion questions at the bottom of the page of each scenario. You may also choose to write the questions on flip chart paper in front of the group for reference. The following questions accompany each scenario: 20
• • •
What factors about the disability make this person vulnerable to violence? How is the violence in this scenario similar to violence experienced by people without disabilities? How is it different? Where was power used inappropriately? How could power have been used appropriately?
4. Allow 10 minutes for groups to read their scenario and record their answers to the questions. 5. Ask a representative from each small group to share their observations with the large group. (To save time, you may want to highlight points about each scenario on flip chart papers ahead of time and hang in room. Each group can read the highlights as an introduction to their scenario, rather than reading the entire paragraph). 6. Make two columns on a flip chart: “similarities” and “differences”. As groups report about their scenario, record the similarities and differences shared. a. Similarities: how the violence experienced by persons with a disability is similar to violence against persons without disabilities, i.e.: control, physical abuse, financial abuse, etc. b. Differences: how the violence experienced by persons with a disability is different from violence experienced by persons without disabilities, i.e. withholding medications or assistive devices, etc. During discussion, trainers may refer to the handouts titled Risk Factors for violence Many People with Disabilities and Disabilities- Specific Types of Abuse Experienced by People with Disabilities POINTS TO ADDRESS: 1. Disability-related factors that may be targets for the perpetrator’s violence: • Nature and severity of the disability • Dependency on caregivers • Social isolation • Lack of control or choice over her/his personal affairs • Lack of credibility when she/he reports or discloses abuse or violence • Lack of opportunities to develop social skills and social connections • Perception of vulnerability and incompetence • Negative attitudes about disability • Limited access to information – individuals may not have learned skills necessary for communicating about sex, setting boundaries, identifying inappropriate behaviors and unhealthy relationships. • Compliance – many people with disabilities, especially cognitive disabilities, have not been taught they have the right to say ‘no.’ This inability to assert oneself may carry over into all aspects of life. 2. Sexual and domestic violence may sometimes include other abuse for persons with disabilities: • Withholding medications 21
• • • • • • • • • •
Withholding or damaging assistive devices such as walkers, canes, wheelchairs, oxygen, etc. Withholding personal care/assistance Taunting him/her about the disability Rough handling Refusing to fix meals or feed the person Making the individual lie in her/his own waste or remain unwashed Withholding disability benefits, money, or food stamps Withholding access to communication (interpreters/TTY) Forced sterilization, abortion, or other birth-denying rights of choice Threatening institutionalization (e.g., nursing home)
3. A perpetrator of violence may be the caregiver for the person with a disability; therefore the person with a disability may not feel safe to report the abuse. Give participants a copy of handout, Red Flags for an Abusive or Potentially Abusive Caregiver. NOTE TO TRAINERS: There are five scenarios. You may decide how many to use based on the size of your group. VIDEO If time, show the 7-minute video, “End the Silence” to end Module 1. This video is produced by the Institute on Disabilities at Temple University (phone: 215 - 204 -1356, estimated cost: $20). It is also available for loan from the NC Coalition Against Sexual Assault and NC Coalition Against Domestic Violence.
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AT RISK
SCENARIO 1 Sasha is a 30-year woman who is deaf. She has two children. Sasha has been physically and emotionally abused by her hearing husband. She communicates using American Sign Language and is a minimal speech (lip) reader. Her husband often hides or damages her TTY telephone to isolate her and the children. The children have also been forced to watch him beat up their mother and their pet dog. Sasha taught her 9year old daughter to call 911 when Sasha is being battered. The police have come to the house numerous times. Until now, Sasha has never pressed charges. However, this time when her daughters were called into the parents’ bedroom to witness their father attempt to strangle her, Sasha decided to press charges and move out. Since she is financially dependent on her husband and has never been employed, Sasha and her daughters have no resources to find another place to live on their own. Thus, she and her daughters moved in with Sasha’s mother, who then called the local battered women’s shelter. The husband was soon released but was arrested again for stalking and publicly attacking his wife and children.
1. What factors about the disability make this person vulnerable to violence?
2. How is the violence in this scenario similar to violence experienced by people without disabilities? How is it different?
3. Where was power used inappropriately? How could power have been used appropriately?
23
AT RISK
SCENARIO 2
Joan, a woman in her late 40’s, has post-polio syndrome and uses a walker. Throughout her childhood, her grandfather and her uncle sexually abused her. She has been married for over 15 years to a man who is both physically and emotionally abusive. He sometimes hides her walker when she is in bed. Joan is isolated from other people. Recently her husband had a stroke, and her abusive uncle has come back into her life to assist with her husband’s care. The sexual abuse has resumed. Two of Joan’s cousins went to the trailer and took her away. They have called your agency for shelter. Joan is depressed and suicidal.
1. What factors about the disability make this person vulnerable to violence?
2. How is the violence in this scenario similar to violence experienced by people without disabilities? How is it different?
3. Where was power used inappropriately? How could power have been used appropriately?
24
AT RISK
SCENARIO 3 Sue is in her late 20’s. She is blind and uses a guide dog. Sue is very independent and lived alone for several years until she got married. She and her husband bought a house together; Sue purchased all the furnishings. The abuse began slowly. Her husband started to scare her by running up and shouting in her face and then running away to another part of the room. He moved things in the house so that she would trip and fall. Her husband demanded that Sue not call her friends and family. He hid the phone when leaving the house. Sue’s husband would lie about the bills, and then he would forge checks to pay the bills. Sometimes he also kept her disability check. She managed to leave one day and is staying at a friend’s house in another city. She learned that her husband has run all the credit cards up to the limit. He is currently living in their house with another woman. Sue wants to divorce him, sell the house, and get out of debt. She has no financial resources and her credit rating is poor now. Sue was referred to your agency by another domestic violence agency out of the area.
1. What factors about the disability make this person vulnerable to violence?
2. How is the violence in this scenario similar to violence experienced by people without disabilities? How is it different?
3. Where was power used inappropriately? How could power have been used appropriately?
25
AT RISK
SCENARIO 4 Elizabeth was born with a moderate intellectual disability (sometimes referred to as mental retardation) and currently lives in a group home. She is 30 years old and comes from a large family. Elizabeth likes to go home on the weekends because she enjoys being with her family. When she visits home, she cries and says she does not want to go back to the group home. Her mother asked Elizabeth what happens at the group home to upset her so. She revealed that a staff person, Gary, comes into her bedroom at night and makes her have sex. He taunts Elizabeth about her disability and tells her it’s okay to do this and not to tell anyone. Elizabeth tried to tell other staff about the sexual encounters, but no one listens or believes her. They think she is trying to get attention. Elizabeth’s mother called the group home, but no one could account for this report by Elizabeth. Elizabeth continues to be upset when she visits her family. Her mother called a case manager, filled her in on the situation, and set up an appointment for counseling for Elizabeth.
1. What factors about the disability make this person vulnerable to violence?
2. How is the violence in this scenario similar to violence experienced by people without disabilities? How is it different?
3. Where was power used inappropriately? How could power have been used appropriately?
26
AT RISK
SCENARIO 5 Sam is a 54-year old man with multiple sclerosis who uses a wheelchair. He lives in a rural area with his wife. Sam’s MS has deteriorated such that he needs assistance to get in and out of bed, dress and undress, use the bathroom, and prepare meals. He now needs more help than his wife can provide. His wife hired a personal care assistant, Beth, to assist Sam 5 mornings a week. With the new help available, his wife has grown more distant, is emotionally abusive to him, and stays away from home for days at a time. After a few months, Sam noticed that money was often missing from his wallet and from his hidden stash in the bureau. Sam suspected Beth. Beth convinced Sam that it was just his imagination. Sam told his wife about the missing money, but she said that no one providing personal care assistance would take it. She scolded him for accusing a good lady like Beth and reminded Sam he was a burden. Eventually, Beth became more explicit in taking money and providing less care. She sometimes withheld Sam’s medications and refused to give him a bath. On several occasions, she hit and pinched Sam to “let him know what he could expect if he said anything.” One day after helping herself to a meal from Sam’s kitchen, Beth took all the money in Sam’s wallet and said she had to leave early and would not be back for several days. Sam has called your agency for help.
1. What factors about the disability make this person vulnerable to violence?
2. How is the violence in this scenario similar to violence experienced by people without disabilities? How is it different?
3. Where was power used inappropriately? How could power have been used appropriately?
27
RED FLAGS
FOR AN ABUSIVE OR POTENTIALLY ABUSIVE CAREGIVER BEWARE if a caregiver or attendant: • Has a past history or reports of abusive behavior, and/or criminal record of physical violence or sexual offenses against partners, people with disabilities, seniors, children or animals; •
Is unwilling to provide you, a home health agency or a service agency with a criminal background check or references;
•
Is under the influence of alcohol or illegal drugs while providing you with personal care services;
•
Continually refuses to follow your directions regarding how you need your care provided;
•
Tells you that because he/she works for an outside agency, you are not his/her supervisor and therefore he/she does not have to do what you ask them to do;
•
Uses manipulation and control when you try to assert yourself about your personal needs;
•
Intimidates you physically or emotionally by the way he/she handles your personal needs or by not attending to your personal needs;
•
Treats you and/or your body like an object or without regard or is unnecessarily rough when performing personal care tasks;
•
Continues to treat you in a patronizing way even when you have asked him/her to stop or tries to punish you or control your behavior as if you were a child;
•
Attacks your self-esteem through verbal and/or emotional abuse;
•
Takes away or threatens to take away your adaptive/medical equipment needed for your daily functioning or survival (i.e., respirator, wheelchair, telephone, communication device, walker, TTY or hearing aid, etc.);
•
Does not assist you or threatens to not assist you with medications necessary for your daily functioning or survival;
•
Controls your money. Disability Services ASAP (A Safety Awareness Program) of SafePlace, Austin, Texas, 2002
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RISK FACTORS FOR VIOLENCE FOR MANY PEOPLE WITH DISABILITIES
Research indicates that people with disabilities experience violence more frequently than people without disabilities. Some perceived vulnerability factors include: •
Persons with physical disabilities may depend on others to meet some of their basic needs. Care providers may be involved in the most intimate and personal parts of the individual’s life, which can increase the opportunity for abusive acts. Persons with physical disabilities may also be less likely to defend themselves or to escape violent situations.
•
Persons with cognitive limitations may be overly trusting of others and easier to trick, bribe, or coerce. They may not understand the differences between sexual and non-sexual touches. Persons with cognitive disabilities who experience violence may not understand that the violation is not normal, especially in cases of sexual abuse.
•
Persons who are deaf may not be able to report due to barriers with communication (including lack of an interpreter and/or assistive devices).
•
Persons with speech disabilities may have limited vocabulary or communication skills that can pose barriers to disclosing abuse. They may be misunderstood or viewed as intoxicated or making a prank call when making a report.
•
Many people with disabilities are taught to be obedient, passive, and to control difficult behaviors. This compliance training teaches them to be “good” victims for abuse.
•
Many persons with disabilities grow up without receiving sexuality education, abuse prevention information or self-defense training. They may lack knowledge about their bodies, healthy relationships, and how to protect themselves.
•
A person who has a mental health disability can be vulnerable to victimization if they have difficulty discerning between reality and fantasy, are dependent on others for their mental and physical care, view themselves as unworthy, do not trust their instincts, and/or misinterpret the intentions of others.
•
Perpetrators may perceive individuals with disabilities as easy targets.
•
Society generally views people with disabilities as non-sexual, lacking intelligence, and not credible witnesses.
•
In general, social isolation is associated with higher risk for sexual abuse. Unfortunately, many people with disabilities still face barriers to fully participate in the community and remain socially isolated. Disability Services ASAP (A Safety Awareness Program) of SafePlace in Austin, Texas, 2002.
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DISABILITY-SPECIFIC TYPES OF ABUSE EXPERIENCED BY PEOPLE WITH DISABILITIES
•
Withholding medication.
•
Withholding personal care or assistance.
•
Withholding needed medical equipment like walkers, canes, wheelchairs, etc.
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Rough handling such as 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 the tub).
•
Refusing to fix meals or feed the person.
•
Making the individual lie in her own waste or remain unwashed/bathed.
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Withholding benefits/money or controlling the person’s finances.
•
Withholding access to communication such as sign language interpreters and TTY.
•
Forced sterilization, abortion, or other birth-denying rights of choice on reproductive issues.
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MODULE 2 DISABILITY- FRIENDLY SERVICES
INTRODUCTION AND OVERVIEW ACTIVITY 1: Interacting with People with Different Types of Disabilities ACTIVITY 2: Role-Plays ACTIVITY 3: Resources ACTIVITY 4: “Credo for Support” video
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MODULE 2 DISABILITY- FRIENDLY SERVICES INTRODUCTION AND OVERVIEW TIME: 5 minutes BACKGROUND: Taking a few minutes to set the stage for training makes for a smoother training experience. This Introduction and Overview provides the opportunity to state the goal of the Module, give an overview of the content, explain the roles of the facilitators and participants, and agree on group guidelines. OBJECTIVES: At the end of this activity, participants will have: 1. Learned the goal of training and reviewed the agenda. 2. Understood their roles and the role of the facilitator(s). 3. Agreed on Group Guidelines. MATERIALS: • Flip Chart • Marker STEPS: 1. Welcome participants and give an overview of the training. You may want to write down the Goal and Agenda and post them in the room. • •
•
•
Goal: the goal of our training session is to share and practice strategies on working with individuals with disabilities. Overview/Agenda: Our agenda for this session includes the following activities: learn about communicating with people with different types of disabilities, apply skills through role-plays, participate in an exercise on resources for clients with disabilities, and lastly view a video that suggests ways to effectively interact with individuals with disabilities. Roles: This room is full of people with a wealth of ideas and experiences. We want you to share them. Your role is to participate actively during training. The role of the facilitator is to guide discussion and emphasize important take-home messages. Guidelines: Let’s look at these sample Group Guidelines. Does anyone want to add to this list? Does everyone agree to follow these guidelines during our training time together?
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Group Guidelines • Start and end on time. • Respect others’ opinions. • Ask for clarification. • Create a safe place for expression. • Share your own experiences. • Maintain confidentiality. • Members participate in all phases of the process as they choose.
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ACTIVITY 1 INTERACTING WITH PEOPLE WITH DIFFERENT TYPES OF DISABILITIES TIME: 50 minutes BACKGROUND: This activity provides communication tips and rules of etiquette that will help service providers and persons with disabilities feel more comfortable. Participants learn general recommendations as well as some disability-specific suggestions to improve interaction skills. OBJECTIVES: At the end of this activity, participants will have: 1. Understood strategies for effectively interacting with individuals with different types of disabilities 2. Shared their ideas for relationship-building with people with disabilities MATERIALS: • Handouts o Tips and Strategies for Interacting with People with Disabilities o Fundamental Principles for Effective Intervention with People with Disabilities o Establishing Effective Working Relationships with Clients with Disabilities o Safety Planning for People with Disabilities Preparing to Leave an Abusive Situation o Checklist for Persons with Disabilities: What to Take with You when You Leave an Abusive Relationship o Suggested Intake Questions STEPS: 1. Introduce the idea of “Communicating with People with Disabilities.” • It is important to understand how disability may affect one’s functioning, how people with disabilities can access services, and how a service provider, like you, might provide services and make accommodations when needed. • This is not meant to be an all-encompassing discussion of disabilities. There are many disabilities and medical conditions. We can provide you with disability resources to get more information about specific types of disabilities if you want to learn more. • It is necessary to remember that people with disabilities are unique individuals, and that the most useful information about their disability and life experience will come from them, if you ask. • And, of course, people are people. Our medical conditions, diseases, illnesses, or disabilities do not solely define us. • The purpose of this activity is to provide some guidelines for effective interactions with people with disabilities. There are no hard and fast rules about how to 34
interact with people with disabilities. However, there are some general guidelines about etiquette, respect, and accommodations.
2. Distribute handouts. Each participant should receive a packet of materials. 3. Share the communication strategies for each type of disability using the handout, Tips and Strategies for Interacting with People with Disabilities. Read or paraphrase all the sections of the handout, including the general communication tips and peoplefirst language; hearing loss; vision loss and service animals; and speech, cognitive, mental health, and mobility disabilities. We strongly encourage agency trainers to partner with persons with disabilities as co-trainers for this activity. The lived experience of a person with a disability is an invaluable experience. 4. Highlight ideas from Fundamental Principles for Effective Intervention with People with Disabilities. 5. Next, go around the room and ask participants to read some of the items from Establishing Effective Working Relationships with Clients with Disabilities. You may want to discuss or give examples for some of the suggestions. 6. Review Suggested Intake Questions and discuss the importance of including one of these questions on your client intake form. The client’s response to the intake question may identify how to best provide sexual or domestic violence services. The client may identify assistance or an accommodation that is needed while receiving services at your agency.
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TIPS AND STRATEGIES
FOR INTERACTING WITH PEOPLE WITH DISABILITIES DISABILITY IN GENERAL 1. COMMUNICATION TIPS: • Relax. Be yourself. Don’t be embarrassed if you happen to use accepted, common expressions such as "See you later" or "Got to be running along" that seem to relate to the person’s disability. • Offer assistance to a person with a disability if you feel like it, but wait until your offer is accepted BEFORE you help. Listen to any instructions the person may want to give. • Be considerate of the extra time it might take for a person with a disability to get things done or said. Let the person set the pace in walking and talking. • When talking with someone who has a disability, speak directly to that person rather than through a companion who may be present. • It is appropriate to shake hands when introduced to a person with a disability. People with limited hand use or who wear an artificial limb do shake hands. 2. USE PEOPLE-FIRST LANGUAGE: The way a society refers to persons with disabilities shapes its beliefs and ideas about them. Using appropriate terms can foster positive attitudes about persons with disabilities. People-first language emphasizes the person, not the disability. By placing the person first, the disability is no longer the primary, defining characteristic of an individual but one of several aspects of the whole person. It refers to the person first and then to the situation or disability, if it’s relevant. For example, it is preferred to say, "people with disabilities" instead of "the disabled." People first language is respectful, and it addresses people as individuals. • Following are some examples of appropriate language compared with negative “labels” (people first language).
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People-First Language People with disabilities
Not People-First Language The disabled
Woman who uses a wheelchair
Wheelchair-bound woman
Girl with epilepsy
Epileptic girl
Woman with Down Syndrome
Mongoloid
Man who is deaf
The deaf and dumb
Boy with cerebral palsy
Suffering from cerebral palsy
Woman with a mental health disability
Crazy lady
Man of short stature
A midget
Boy with autism
Autistic boy
People without disabilities
Normal person
HEARING LOSS This disability can range from mild hearing loss to profound deafness. Some persons who have hearing loss use hearing aids or other assistive devices. Others may rely on speech read (lip reading) or sign language, but many do not. COMMUNICATION TIPS: • To get the attention of a person who is deaf or hard of hearing, tap the person on the shoulder or wave your hand. • Follow the person’s cues to find out if he/she prefers sign language, gesturing, writing or speaking. • Look directly at the person and speak clearly, slowly and expressively to establish if the person can read your lips. Those who read lips will rely on facial expressions and other body language to help in understanding. Remember, not all persons who are deaf or hard of hearing can lip read. • Speak in a normal tone of voice. Talking too loudly or with exaggerated speech can cause distortion of normal lip movements. Shouting won’t help. • Place yourself facing the light source and keep your hands and food away from your mouth when speaking. Do not try to communicate while smoking or chewing gum. • Keep mustaches well trimmed. • Try to eliminate background noise. • Written notes can often facilitate communication. • Encourage feedback to assess clear understanding. 37
•
If you have trouble understanding the speech of a person who is deaf or hard of hearing, let him/her know.
VISION LOSS As with hearing disabilities, there is a wide range of vision loss. Some people may have a total loss of vision. Others have limited vision with correction. COMMUNICATION TIPS: • When greeting a person with a severe loss of vision, always identify yourself and others who may be with you. Say, for example, "On my right is Penelope Potts." • When conversing in a group, remember to say the name of the person to whom you are speaking to give vocal cues. • Speak in a normal tone of voice, indicate when you move from one place to another and let it be known when the conversation is ending. • When you offer to assist someone who has vision loss, allow the person to take your arm. This will help you to guide rather than propel or lead the person. When offering seating, place the person’s hand on the back or arm of the seat. • Let the person know if you move or need to end the conversation. Let the person know if you leave or return to a room. • Use specifics such as "left a hundred feet" or "right two yards" when directing a person with a visual disability.
SERVICE ANIMALS An important component of interacting with a person with a disability can be knowing how to interact with that person’s service animal. Service animals, such as guide dogs for persons who are blind and assistant monkeys for persons with dexterity limitations, should not be considered pets. They are working animals. Following are a couple of rules for interacting with service animals. • Service animals should not be petted or otherwise distracted when in harness. • If the animal is not in harness, permission from the animal’s companion should be requested and received.
SPEECH DISABILITIES Speech disabilities are seldom related to intelligence. A person who has experienced a stroke, is severely hard of hearing or has a stammer or other type of speech disability may be difficult to understand. COMMUNICATION TIPS: • Give whole, unhurried attention when you’re talking to a person who has difficulty speaking. Allow extra time for communication. • Keep your manner encouraging rather than correcting. Be patient - don’t speak for the person. • If necessary, ask short questions that require short answers or a nod or shake of the head. 38
• •
Never pretend to understand if you are having difficulty doing so. Repeat what you do understand. The person’s reaction may help verify that you really understand Use hand gestures and notes.
COGNITIVE DISABILITIES Cognitive disabilities include intellectual and learning disabilities and can result from conditions such as traumatic brain injury or Alzheimer’s disease. COMMUNICATION TIPS: • Be patient. Take the time necessary to assure clear understanding. Give the person time to put his/her thoughts into words, especially when responding to a question. • Use precise language incorporating simpler words. When possible, use words that relate to things you both can see. Avoid using directional terms like right and left. Instead say, “Her office has a blue door.” • Be prepared to give the person the same information more than once in different ways. • When asking questions, phrase them to elicit accurate information. People with cognitive disabilities may be eager to please and may tell you what they think you want to hear. Verify responses by repeating each question in a different way. Give exact instructions. For example, "Be back from lunch at 12:30," not "Be back in 30 minutes." • Too many directions at one time may be confusing. • Depending on the disability, the person may prefer information provided in written or verbal form. Ask the person how you can best relay the information.
MENTAL HEALTH DISABILITIES People with mental health disabilities may have thoughts, behaviors and feelings that distress them and/or other people. Their thoughts and actions may not appear to be reasonable to others. Mental health disabilities are often episodic, with people experiencing long periods without any symptoms. Examples of mental health disabilities include depression, bi-polar disorder and schizophrenia.
COMMUNICATION TIPS: • Listen and be attentive. Being heard is important to all people, but it is especially important to people with mental health disabilities because they are often disregarded and discounted. Medical complaints are often ignored and treated as psychological issues rather than physical. • Validate the person’s perspective. Often, the opinions of people with mental health disabilities are not respected. It is especially important that the individual feel that he or she has been heard and validated. • Avoid arguments with the person. This leads to distrust and alienation. 39
MOBILITY DISABILITIES Mobility disabilities can affect coordination or use of muscles and may be attributed to various injuries or conditions that limit one’s ability to get around, such as spinal cord injury, spina bifida, cerebral palsy, amputation, etc. Often persons with mobility disabilities use assistive devices such as a wheelchair, cane, or walker. COMMUNICATION TIPS: • Remember that any aid or equipment a person may use, such as a wheelchair, guide cane, walker, crutch or assistance animal, is part of that person’s personal space. Don’t touch, push, pull or otherwise physically interact with an individual’s body or equipment unless you’re asked to do so. • When speaking with someone in a wheelchair, talk directly to the person at his/her eye level, if possible. If you must stand, step back slightly so the person doesn’t have to strain his/her neck to see you. • When giving directions to people with mobility limitations, consider distance, weather conditions and physical obstacles such as stairs, curbs and steep hills they might face. • Always ask before you push someone in a wheelchair to prevent disturbing the person’s balance. • If a person transfers from a wheelchair to a car, barstool, bathtub, toilet, etc., leave the wheelchair within easy reach. Always make sure that a wheelchair is locked before helping a person transfer.
NOTE TO TRAINERS: The NCODH free publication, ”Tips and Strategies for Effective Communication” is a useful resource. Go to http://www.fpg.unc.edu/~ncodh to order a free copy or download.
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FUNDAMENTAL PRINCIPLES
FOR EFFECTIVE INTERVENTION WITH PEOPLE WITH DISABILITIES •
Assume that people with disabilities are capable.
•
Move beyond traditional ideas that assume the problem of disability lies with the person with a disability and that they need to be “fixed” or “cured.”
•
Understand that there are historic and cultural influences that shape the experience of disability.
•
Assume that there can be joy in living with disability, not just in spite of it or by “overcoming” it.
•
Accept and defend the right of all people with disabilities to control their own lives.
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ESTABLISHING EFFECTIVE WORKING RELATIONSHIPS WITH CLIENTS WITH DISABILITIES
•
• • • • • •
• • • • • • •
•
First ask the individual with a disability about any assistance or accommodation (such as extra time, having things explained more slowly, having an interpreter, etc.) she/he may need in order to participate in counseling sessions or group activities. Allow individuals to name their experience and demonstrate your belief in and respect for their struggle as well as their strength as a survivor. Try not to confuse this respect with the “you’re so brave for having a disability” stereotype. See people with disabilities as whole people. Allow survivors to identify the issues they most want to work on and don’t assume that the things that are troubling them are disability-related. Avoid assumptions that people with disabilities are not employed or do not have sex lives. Deal with loss and grief when appropriate, but don’t assume all people are dealing with loss and grief. Deal with effects of oppression, such as isolation, a sense of social betrayal, fear of authority, sadness about past mistreatment or exclusion, social insecurity or immaturity, and fear of loss of freedom. Deal with the unique issues of those who have been hospitalized or institutionalized, including fear of abandonment, trauma from years of invasive medical treatment, separation from loved ones, forced medications or other treatments, loss of freedom through commitment, and physical or sexual abuse by caregivers. Help individuals identify their strengths and capacities and build on them. Hold and communicate a positive outlook for the future. Assist people with disabilities to connect with other people with disabilities as role models. Assist people with disabilities to learn more about their legal rights, including the right not to be discriminated against in housing, transportation, employment, government services, and public accommodations. Assist survivors in exploring community resources and social supports that may allow them to be more independent. Attend to spiritual needs of survivors and assist them to find connections with accessible and disability-positive spiritual resources and faith communities. Offer to assist clients to make connections with peers with disabilities who are involved in political and social action. Developing a positive disability identity and relevant social group affiliation can be an important vehicle for personal empowerment and healing. Seek out and work in partnership with colleagues with disabilities who might offer valuable insights, training, consultation, support, or intervention. 42
SAFETY PLANNING
FOR PEOPLE WITH DISABILITIES PREPARING TO LEAVE AN ABUSIVE SITUATION
A safety plan is a unique strategy to reduce the risks of abuse or violence, which may include escaping a dangerous situation. Each person's plan is individualized for her/his situation and may be altered at any time. The following are ideas to consider for women or men with disabilities, but are not in any particular order of importance. •
If you are thinking about leaving, do not let your abuser know of your plan to escape. Be careful not to leave clues regarding your destination (i.e., long distance phone bills or literature about domestic violence services).
•
Change your payee (if you have one) on your SSI/SSDI benefit to someone you trust other than the batterer. You (or a caseworker from a domestic violence, disability service agency or Adult Protective Services) will need to contact the Social Security Administration to change the payee name.
•
Open a savings account in your name only. Have your benefit checks direct deposited into that account. If possible, try to set aside as much money as you can. If you have joint accounts with your spouse or partner, try to take all of your money out and put it in your own account. It may seem sneaky or it may even be risky for you, but it may mean your survival.
•
Plan for assistance with personal care tasks. Be prepared to receive this assistance from someone else besides the batterer. Ask several friends, family members or faith community members for help if possible so that one person is not over-taxed.
•
If you receive Medicaid/Medicare and are low income, you may be entitled to services from the NC Department of Health and Human Services. Some home health care agencies have rates based on income. Contact a caseworker or an intake worker and let them know about your service needs. If at first she/he does not respond or assist, call again and ask for a status report or for an explanation about why services have not been initiated. If they still do not respond, ask to speak to their supervisor.
•
Get a post office box in your own name and hide the key or give it to a trusted friend or relative.
•
Gather money, extra set of keys, medications, spare adaptive aids or medical supplies, a packed bag with a few changes of clothes for you and your child(ren) and leave those items at the home of a trusted friend or relative. Assess your own resources. Figure out if you have people (i.e., friends, family, church or synagogue members, etc.) who would be able to let you stay with them or lend you some money to make the transition. 43
•
•
Make sure if you drive an adapted vehicle that the adaptations are in good repair and the vehicle itself is in reasonable working order. Have your vehicle checked often in case the abuser has tampered with it in any way. Never leave your vehicle with less than half a tank of gas. This is so that if you need to leave in a hurry, you have a reasonable amount of gas available.
•
If you live in a major metropolitan area, consider applying for para-transit services. A doctor or caseworker can certify your disability if you have seen them for services before. This may even be done by mail.
•
Call the battered women's shelter in your area (or the National Domestic Violence Hotline at 1-800- 799-SAFE; 1-800-787-3224 (TTY) to discuss safety planning. Let them know what your needs are and that you have a disability. Inquire about accessibility. Be aware that shelters are often full. More than likely, the shelter is not turning you away because of your disability. Ask to be put on the waiting list and check back with them daily to inquire about the availability of space at the shelter. Remember, safety planning is very, very important at this stage of the process. Stay in touch with your local hotline. Ask them for help to strategize with safety planning. A woman is much more likely to be killed upon leaving a relationship than at any other time.
•
Keep the battered women's shelter or domestic violence or other crisis hotline telephone number with you. Better yet, memorize it! Keep some extra change with you for phone calls. Most shelter hotlines will take collect calls.
•
Call and talk with other disability-related service providers and disability rights organizations listed in the phone book (i.e., support groups, coalitions, independent living centers, etc.) and ask for assistance with locating accessible or other support services.
•
Call Adult Protective Services (APS) and report the abuse. Let them know if your health and safety are at stake. They must take down all self-reports. Ask APS what the process will be for investigation and services. Not all APS reports end in a facility placement. If you are not willing to tolerate a facility placement, then let the social worker know that. There are emergency options other than an institutional setting and APS may be able to set up other temporary emergency services.
•
When you leave, write a note to the abuser that says you went to a doctor's appointment or another place that will not make the abuser suspicious. This will give you a head start.
•
If you use a credit card after leaving, make sure that the bill will not be sent to the residence where the abuser lives or has access.
•
If, after you leave, you need to telephone anyone who knows the abuser, be careful that your location cannot be traced through caller ID or call return.
•
Leaving an abusive relationship is a process for people with disabilities just like it is for people without disabilities. For individuals with disabilities, this process can be longer because of all the logistics. Leaving an abusive relationship is one of 44
the bravest, most frightening experiences a person can go through. Being abused is not your fault and neither is having a disability. •
Only you know your batterer best. Use the steps that make sense for your personal situation. If something does not feel safe and might put you or your children in further danger - don't do it!
•
Remember there is hope. There are options. There is a way out.
This document is not intended to be all-inclusive, nor do any of the suggestions provided in this document guarantee personal safety. Disability Services ASAP (A Safety Awareness Program) of SafePlace, Austin, Texas, 2002
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CHECKLIST FOR PERSONS WITH DISABILITIES:
WHAT TO TAKE WITH YOU WHEN YOU LEAVE AN ABUSIVE RELATIONSHIP IDENTIFICATION Driver's license or state I.D. card Your and your children's (or other family member's) birth certificates Social Security card or Social Security award letter Proof of disability Food stamps Insurance, Medicaid, Medicare and/or clinic card MONEY
Money, credit cards and/or ATM card Bank books, account information and checkbook If applicable, information on stocks (including stock certificates), bonds, and individual retirement account(s), mortgage
LEGAL PAPERS Lease or house payment information/deed to the house (even if you do not plan to live there) Car registration and car insurance papers Health and life insurance papers Medical records and doctor's orders Children's school records and shot records Work permits (green card, VISA) Passport Divorce papers Child custody papers Protective or Restraining Order OTHER IMPORTANT DISABILITY-RELATED ITEMS Adaptive equipment (wheelchair, shower bench, crutches, hearing aids, communicative devices, etc.) Medications, prescriptions and doctor's orders Urological or colostomy supplies Service animal and needed supplies for their care Names and phone numbers of home health agencies, caseworkers and other disability service providers to assist in coordinating services for you Phone numbers of friends or past attendants who might be willing to help with personal care tasks during the transition period and also provide you with some emotional support Fixed route bus pass, Mobility ID card or Special Transit ID card Medical records 46
MISCELLANEOUS ITEMS House, car, and office keys Small objects to sell Jewelry Address book Pictures of you, your children, and your grandchildren Evidence of physical abuse and pictures of the abuser Children’s small, favorite toys Toiletries and diapers Cellular phone programmed to 911 (these can often be obtained for free though a local domestic violence program)
Disability Services ASAP (A Safety Awareness Program) of SafePlace, Austin, Texas, 2002
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SUGGESTED INTAKE QUESTIONS During intake ask one of the following questions to assess the client’s needs (or ask similar questions of your own choosing). The client may identify assistance or an accommodation that is needed while receiving services at your agency. The client’s response may identify how to best provide sexual or domestic violence services. Examples of accommodations might include assistance with communicating, a sign language interpreter, alternate formats of written materials (i.e. large print) or using simple language. Suggested Questions: •
We are working toward becoming accessible. Please tell us if you need any accommodations.
•
Do you have any needs that we can assist you with while receiving services from us?
•
We would like to accommodate your needs. Please tell us what needs you might have.
•
Do you (or others) consider yourself to have a disability? What, if any, help will you need while you receive services from us?
•
Do you need any extra help? (This question may be most appropriate for clients with cognitive disabilities.)
Taken from Stop the Violence, Break the Silence. SafePlace, Austin, TX, 2002
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ACTIVITY 2 ROLE-PLAYS TIME: 30 minutes (5 minutes to introduce material, 10 minutes for role-play and discussion; 15 minutes to report to large group) BACKGROUND: This activity provides participants the opportunity to act out and discuss a role-play in which a service provider helps a person with a disability who has experienced sexual assault or domestic violence. Each participant will participate in a role-play scenario and will play the part of client or service provider. OBJECTIVE: At the end of this activity, participants will have: 1. Practiced interacting with a person with a disability through role-play or experienced playing the role of a service provider. MATERIALS: • Role-Play handouts o Role-play 1: Service provider & Client o Role-play 2: Service provider & Client o Role-play 3: Service provider & Client STEPS: 1. Divide participants into pairs. • Each of you will have the opportunity to play the role of client or service provider, using the handouts I will give you. • Remember that you only have about 10 minutes to conduct the role-play. You may find that the interaction feels stylized or artificial, but we want you to have the opportunity to practice some of the communication skills we’ve discussed. • Give each pair the role-play handouts, including both the provider and client handouts. Decide which role each of you will play, and then conduct the roleplay. • Circulate around the room and listen to role-plays to see if anyone has a question or needs any prompts or assistance. • Once the pairs complete the activity, discuss how the role-play went. First, the “service provider” shares her perspective and then the “client” shares. There are discussion questions at the bottom of each scenario that can help guide the discussion. 2. After the role-play has been completed by each group, process the role-play with the large group. • What was your experience playing the role of the client with a disability? • As the service provider, what did you learn about accommodating clients with disabilities?
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NOTES TO TRAINERS: • Monitor the time of role-plays • Be sure to watch the time carefully and keep it moving. Allow at least 15 minutes at the end to process the activity. • After 10 minutes, bring everyone back to the large group. • Make sure participants identify positive skills used in the role-play. Avoid a focus on only critical comments or feedback.
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ROLE-PLAY 1: CLIENT CLIENT: MONICA • Monica is a woman in her 30’s who was born with short arms and legs. She uses a motorized wheelchair. • She is currently married to a physically and emotionally abusive man. Monica is afraid for her life because the abuse has begun to escalate. • She requires personal assistance in all areas of her life. • Her husband has said he will kill her if she tries to leave. • Monica has anxiety about leaving her home and moving into a shelter because of her fears about her personal care and transportation needs. • She has called the domestic violence hotline to discuss the possibility of moving into the local DV shelter.
THE DISCUSSION • How did you react to the service provider? • Is there anything you wish the service provider had done to make you feel more comfortable or to accommodate you? • What challenges did you face accessing the service you needed?
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ROLE-PLAY 1: SERVICE PROVIDER SERVICE PROVIDER: Crisis Counselor, Justine, on the DV hotline • Monica calls the crisis line. You have spoken with her several times. Monica is in her 30’s. She was born with short arms and legs and uses a motorized wheelchair. • Monica requests to go to the shelter. • You ask her, “What, if any, help will you need while receiving services?”
THE DISCUSSION • How did you feel about working with this woman? • What challenges did you face? • What may have helped you to provide appropriate services?
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ROLE-PLAY 2: CLIENT CLIENT: Alma • Alma is 35 years old. She has autism. • Alma has a simple, limited vocabulary. • She lives with her parents, who are in their late sixties. • She spends her days working in a community rehabilitation / employment program. • Alma was sexually assaulted in the bathroom by a co-worker. The assault was reported, and the perpetrator was removed from the employment program. • She is afraid to go into the bathroom at the employment program. • Alma comes to the Center for her appointment to talk about the incident and about her fears.
THE DISCUSSION • How did you react to the service provider? • Is there anything you wish the service provider had done to make you feel more comfortable or to accommodate you? • What challenges did you face accessing the service you needed?
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ROLE-PLAY 2: SERVICE PROVIDER SERVICE PROVIDER: Sexual Assault Counselor, Karen • The community rehabilitation / employment program director contacted the local rape crisis center to get help for a woman in her thirties who has autism. Her name is Alma. • You and the program director decide to set up an appointment for Alma to come in to the Center to meet with you. The meeting is today.
THE DISCUSSION • How did you feel about working with this woman? • What challenges did you face? • What may have helped you to provide appropriate services?
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ROLE-PLAY 3: CLIENT CLIENT: Eloise • She is a woman in her mid-sixties with a communication disability as a result of a stroke. • It can be difficult to understand what Eloise is saying. She often communicates by writing notes. • Over time, her husband has become physically abusive. During one explosive episode, she scratched his face while defending herself. When the police arrived, they arrested her because her husband appeared injured. • Eloise moved out of the house and is living with a friend. • Since her arrest, she is very depressed and angry and feels frightened because her husband continues to stalk her by driving by the house where she is staying. • Eloise goes to the Family Violence Center to meet with a counselor. She is tired of being stalked and distrusts the criminal justice system.
THE DISCUSSION • How did you react to the service provider? • Is there anything you wish the service provider had done to make you feel more comfortable or to accommodate you? • What challenges did you face accessing the service you needed?
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ROLE-PLAY 3: SERVICE PROVIDER SERVICE PROVIDER: Domestic Violence Counselor, Margaret • Eloise is a woman in her mid-thirties with a communication disability as a result of a stroke. • Today you meet with Eloise for the first time. • You have difficulty understanding what Eloise is saying.
THE DISCUSSION
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How did you feel about working with this woman? What challenges did you face? What may have helped you to provide appropriate services?
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ACTIVITY 3 RESOURCES FOR CLIENTS WITH DISABILITIES TIME: 25 minutes BACKGROUND: This activity introduces local, state, and national resources for people with disabilities; and it offers participants the opportunity to match needs with resources. OBJECTIVES: At the end of this activity, participants will have: 1. Learned about local, state, and national resources for people with disabilities. 2. Matched needs with resources. MATERIALS: • Need and resource index cards (create one index card for each need and each resource from the included List of Needs and Resources). • Handout o North Carolina Disability Agencies and Resources STEPS: 1. Introduce the activity. • We have learned that there are many disabilities, and we know that our resources are limited. One of our strengths is to know where to get help if we need it and where to refer our clients for specific services. • It is important to become familiar with the range of supports and services that are available to people with disabilities in order to serve them better. • Remember that people with disabilities have a right to access all community services - not just those with a specific disability focus. • Before seeking services on behalf of a person with a disability, it is important to understand if the individual has any need for specific disability-related accommodations such as a sign language interpreter or materials in alternative formats. • In trying to access services from community organizations that do not have a specific disability focus, it may be necessary to act as an advocate and remind other organizations that they are also covered by the ADA (Americans with Disabilities Act) and may not discriminate against people with disabilities. • Communicate with community agencies in a proactive effort to establish an understanding that they can be relied on to serve people with disabilities. Have a system in place for making referrals and providing services to people with disabilities. • There are community agencies, statewide agencies, and national resources for people with disabilities that can assist you to better serve clients with disabilities. We are going to have the chance to explore some of these resources in this activity. 57
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Give each participant an index card – ½ get one with a need written on it, the others get a card with a community resource written on it. Each participant should have a piece of a “matching pair”. Some of you have an index card with a need written on it, and others have a card with a community resource written on it. Your task is to find the person who has a card that matches your need or resource. Some needs have multiple resources. Before finding your match, first familiarize yourself with the resources by reviewing the handout, North Carolina Disability Agencies and Resources. Then talk amongst yourselves to find out who can help each other. Once you find your “partner,” discuss how you might access this resource. After you’ve reviewed the resources, found your match, discussed how to access the resource, we’ll ask you to describe your need and the resource to the group.
2. Ask one person from each pair to explain their need and resource to the large group and include how they would go about using this resource to help a client.
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LIST OF NEEDS AND RESOURCES NEED
COMMUNITY RESOURCE
Need to call a woman who is deaf
Relay North Carolina
The phone in the shelter needs a volume control
North Carolina Assistive Technology Program
Need to be able to communicate with a client who is hard of hearing in an upcoming counseling session
The Division for the Deaf and Hard of Hearing
Are remodeling the shelter’s bathroom and want to know how to make it accessible
The Center for Universal Design
Need support to work with a client who has an intellectual disability
The Arc of North Carolina
Need assistance with obtaining employment for a client with a disability
The Division of Vocational Rehabilitation Services
Want to learn more about cerebral palsy and the challenges a person with this disability may face
Family Support Network of North Carolina Central Directory of Resources Easter Seals UCP of NC
Need assistance with evaluating the accessibility of the agency
North Carolina Office on Disability and Health
A woman with schizophrenia is moving from the shelter to a new town and will be socially isolated. Need to find a resource to provide social support to minimize her risk for depression.
Mental Health Association of North Carolina
Woman with spinal cord injury is moving out of shelter into a new residence. Need information on how she can get a ramp.
NC Division of Mental Health, Developmental Disabilities and Substance Abuse Services (Local Management Entity) NC Division of Vocational Rehabilitation Services, Independent Living Program The Center for Universal Design
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Need more information about my clients’ rights under the ADA
Carolina Legal Assistance NC Office on the Americans with Disabilities Act
Have a client with Multiple Sclerosis whose crutches were lost. Need more information about how she can replace these.
Multiple Sclerosis Society
Want to translate an agency document into Braille
NC Division of Services for the Blind NC Library for the Blind and Physically Handicapped
Individual with a disability is requesting advocacy to get needed services.
Alliance of Disability Advocates Center for Independent Living
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NORTH CAROLINA DISABILITY AGENCIES AND RESOURCES ALLIANCE OF DISABILITY ADVOCATES, CENTER FOR INDEPENDENT LIVING promotes consumer control by people with disabilities to advance civil rights of equal access and full participation in society. The core services of the Alliance include individual and systems advocacy, peer mentoring and support, information and referral, independent living skills training, and community integration. Based in Raleigh, the ADA-CIL serves the counties of Durham, Franklin, Johnston, Orange and Wake. ALLIANCE OF DISABILITY ADVOCATES CENTER FOR INDEPENDENT LIVING 401 Oberlin Road, Suite 103 Raleigh, NC 27605 Mailing: P.O. Box 12988 Phone. 919-833-1117 (V/TTY) Fax. 919-833-1171 http://www.alliancecil.org E-mail.
[email protected]
ARC OF NORTH CAROLINA and its 44 chapters throughout the state provide a support structure and access to needed services for persons with intellectual and developmental disabilities. Some services offered included supported employment, information and referral, self-advocacy, and community housing. ARC OF NORTH CAROLINA 4200 Six Forks Rd., Suite 100 Raleigh, NC 27609 Toll free. 1-800-662-8706 Phone. 919-782-4632 or 919-782-4634 http://www.arcnc.org/
CAROLINA LEGAL ASSISTANCE is a private, tax-exempt, non-profit legal assistance program that offers legal representation to children and adults with mental illness and developmental disabilities. CLA practices exclusively in the field of mental disability law. CLA serves individuals with mental illness and developmental disabilities throughout the state. Clients reside in the community with their families, in their own apartments, in group homes and other settings, and in state institutions.
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CAROLINA LEGAL ASSISTANCE PO BOX 2446 Raleigh, NC 27602-2466 Phone. 919-856-2195 Fax. 919-856-2244 E-mail.
[email protected] http://www.cladisabilitylaw.org/
CENTER FOR UNIVERSAL DESIGN is a national research, information, and technical assistance center that evaluates, develops, and promotes universal design in housing, public and commercial facilities, and related products. Universal design is the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design. CENTER FOR UNIVERSAL DESIGN College of Design, North Carolina State University 50 Pullen Road, Brooks Hall, Room 104 Campus Box 8613 Raleigh, NC. 27695-8613 Toll free. 800-647-6777 Phone. 919-515-3082 Fax. 919-515-8951 E-mail.
[email protected] http://www.design.ncsu.edu/cud/
EASTER SEALS UCP NORTH CAROLINA offers quality programs to persons with disabilities and their families. Programs include: 1) Durable medical equipment program for people who would not be able to purchase it themselves. This program purchases durable medical equipment, such as wheelchairs, prostheses, orthotics, orthopedic shoes, hospital beds, walkers, canes, prescribed support hose, hearing aids, and bathroom equipment that does not require installation. 2) Information and referral services help individuals with disabilities and their families learn about programs, services, and resources that meet their needs. 3) Individual and family support services help individuals develop the skills necessary to live at home. Services include personal assistance, personal care services, skills training, respite, and the supports necessary for individuals to participate in community activities. 4) Support services facilitate a network of 22 support groups across North Carolina, including 12 Stroke, 7 Post-Polio, and 1 Physically Disabled Adult Support Group. EASTER SEALS NORTH CAROLINA - STATE OFFICE 2315 Myron Drive Raleigh, N.C. 27607-3399 Phone. 919-783-8898 http://nc.easter-seals.org/site/PageServer?pagename=ncdr_homepage 62
FAMILY SUPPORT NETWORK OF NORTH CAROLINA provides support and information to families of children with disabilities by promoting family support and encouraging collaboration among families and service providers in the design and delivery of services. Eighteen local family support programs in North Carolina provide information about local resources and services to families and service providers. Programs match families for emotional support, information, and resources. The Central Directory of Resources (CDR) provides information and referral services. Through the toll-free number, (800) 852-0042, referrals are made to service agencies, family support programs, support groups, and disability organizations on local, state, and national levels. Printed information on diseases, disabilities, chronic illnesses and related issues is also available from the CDR. FAMILY SUPPORT NETWORK OF NORTH CAROLINA CB# 7340, University of North Carolina at Chapel Hill Chapel Hill, NC 27599-7340 Phone. 919-966-2841; Toll free.800-852-0042 Fax. 919-966-2916
[email protected] http://fsnnc.med.unc.edu/
MENTAL HEALTH ASSOCIATION OF NORTH CAROLINA promotes mental health and works to prevent mental disorders and eliminate discrimination against people with mental disorders. They accomplish these goals through community advocacy, education, and services. MENTAL HEALTH ASSOCIATION OF NORTH CAROLINA 3820 Bland Road Raleigh, NC 27609 Phone. 919-981-0740; Toll Free. 888-881-0740 Fax. 919-954-7238 http://www.mha-nc.org/
THE NATIONAL MULTIPLE SCLEROSIS SOCIETY The National MS Society has 3 chapters in North Carolina. Each chapter provides a variety of programs for people with MS and their families. Each also offers many special events designed to raise funds for MS research and to support people living with MS. Chapter Programs help improve the quality of life of people living with MS and their families by improving knowledge about the disease, emotional health, physical health and independence.
CENTRAL NORTH CAROLINA serves 15 counties in central and western North Carolina. 2211 West Meadowview Road, Suite 30 Greensboro , NC 27407 Phone: 336-299-4136 63
Phone: 1-800-FIGHT-MS Email:
[email protected] Website: http://www.nationalmssociety.org/ncc EASTERN NORTH CAROLINA serves 49 counties of eastern North Carolina. 3101 Industrial Drive, Suite 210 Raleigh , NC 27609 Phone: 919-834-0678 Phone: 1-800-FIGHTMS (1-800-344-4867) Email:
[email protected] Website: https://www.nationalmssociety.org/nct MID-ATLANTIC NORTH CAROLINA serves 33 counties of western North Carolina. 9801-I Southern Pines Blvd. Charlotte , NC 28273 Phone: 704-525-2955 Phone: 800-477-2955 Email:
[email protected] Website: http://www.nationalmssociety.org/ncp NC DIVISION OF MENTAL HEALTH, DEVELOPMENTAL DISABILITIES, AND SUBSTANCE ABUSE SERVICES makes policies and rules and monitors public services to people with mental illness, developmental disabilities, or substance abuse throughout North Carolina. Services are provided through local programs statewide (LME’s or Local Management Entities). NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services 3001 Mail Service Center Raleigh, NC 27699-3001 Phone: 919-733-7011 Fax: 919-733-9455 http://www.dhhs.state.nc.us/mhddsas/ NC DIVISION OF SERVICES FOR THE BLIND empowers individuals who are blind or have low vision to achieve their maximum potential through statewide services provided by staff in seven DSB District Offices and Social Workers for the Blind located in all North Carolina counties. Service categories include training, employment, medical, technology, and daily living skills. North Carolina Services for the Blind 309 Ashe Ave. 2601 Mail Service Center Raleigh, NC 27699-2601 Phone: 919-733-9822 Fax: 919-733-9769 http://www.dhhs.state.nc.us/dsb/ 64
NC DIVISION OF SERVICES FOR THE DEAF AND HARD OF HEARING provides a broad range of services for children and adults, their families, and the professionals who serve them. The division also provides interpreter services, advocacy, access to technology, and coordination of human services for the deaf and hard of hearing. North Carolina Division of Services for the Deaf and Hard of Hearing 2301 Mail Service Center Raleigh, NC 27699-2301 Phone: 919-773-2963 (Voice, TTY) Fax: 919-773-2993 http://www.dhhs.state.nc.us/docs/divinfo/dsdhh.htm
NC DIVISION OF VOCATIONAL REHABILITATION SERVICES’ goal is employment. Vocational rehabilitation counselors work with business and community agencies to help them prepare their worksites to accommodate employees who have physical or mental disabilities. The division also provides services that encourage and reinforce independent living for people with disabilities through two main components: the Vocational Rehabilitation Program and the Independent Living Services Program. NC Division of Vocational Rehabilitation Services 2801 Mail Service Center Raleigh, NC 27699-2801 Phone: 919-855-3500 Fax: 919-733-7968 http://dvr.dhhs.state.nc.us/
NC OFFICE ON THE AMERICANS WITH DISABILITIES ACT provides consultative services to state and local governments, businesses, and industry in complying with the Americans with Disabilities Act (ADA) of 1990. NC Office on the Americans with Disabilities Act 111 E. North St. 1304 Mail Service Center Raleigh, NC 27601 Phone. 919-733-0054 Fax. 919-733-6909 http://www.doa.state.nc.us/doa/ada/welcome.htm
NORTH CAROLINA ASSISTIVE TECHNOLOGY PROGRAM is a statewide system to coordinate assistive technology services. Assistive technology (AT) is any piece of equipment or device that is used to increase the independence of individuals with disabilities. This program’s goal is to increase awareness about AT and provide training, funding information, referral services, technical assistance, and an equipment loan program. 65
Centers are located in Charlotte, Sylva, Winston-Salem, Raleigh, Rocky Mount, Greenville, and Wilmington. North Carolina Assistive Technology Program 1110 Navaho Drive Suite 101 Raleigh, NC 27609 Phone. 919-850-2787 (Voice, TTY) Fax. 919-850-2792 http://www.ncatp.org/
NORTH CAROLINA LIBRARY FOR THE BLIND AND PHYSICALLY HANDICAPPED is a public library that circulates books and magazines especially made for persons who cannot use regular printed material because of a visual or physical disability. The library is located in Raleigh, and mails materials throughout the state. The NCLBPH is a state agency operated by the State Library of North Carolina as a part of the Department of Cultural Resources. It is also a part of the network of regional libraries operated by the Library of Congress National Library Service for the Blind and Physically Handicapped. Open 8:00 A.M. - 5:00 P.M., Monday – Friday. NC Library for the Blind and Physically Handicapped Toll Free. 1-888-388-2460 (Nationwide) Phone. 919-733-4376 (Raleigh area residents); TDD. 919-733-1462 Fax. 919-733-6910 E-mail.
[email protected] http://statelibrary.dcr.state.nc.us/lbph/lbph.htm
NORTH CAROLINA OFFICE ON DISABILITY AND HEALTH works to promote the health and wellness of persons with disabilities in North Carolina. NCODH works to increase awareness and understanding of the health-related needs of individuals with disabilities; improve access and inclusion; and develop health promotion programs and educational materials for consumers and professionals. As part of the women’s health initiative, the office is available to provide technical assistance to domestic violence and sexual assault agencies around accessibility issues and staff training.
NC Office on Disability and Health Campus Box 8185, The University of North Carolina at Chapel Hill Chapel Hill, NC 27599-8185 Fax. 919-966-0862 E-mail.
[email protected] http://www.fpg.unc.edu/~ncodh
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Division of Public Health 1928 Mail Service Center Raleigh, NC 27699-1928 Fax. 919-870-4880 E-mail.
[email protected] http://wch.dhhs.state.nc.us/cay
RELAY NORTH CAROLINA provides telephone accessibility to people who are deaf, hard of hearing, or speech limited. Relay North Carolina is available 24 hours a day, 365 days a year with no restriction on the number of calls placed or on their length. Standard telephone users can easily initiate calls to TTY users by calling 711. The relay operator then types the hearing person’s spoken words to the TTY user and reads back the typed replies. Dial 711 or call 1-877-735-8200 (Voice) 1-888-825-2448 (Spanish)
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ACTIVITY 4 CREDO FOR SUPPORT VIDEO TIME: 10 minutes BACKGROUND: Viewing this video provides participants the opportunity to review important strategies and skills for effectively interacting with people with disabilities. OBJECTIVES: At the end of this activity, participants will have: 1. Reviewed many tips for working with people with disabilities. MATERIALS: • Credo for Support video (can be purchased through Axis Consultation & Training, phone: 250-754-9939, fax: 250-754-9930, estimated cost: $30) It is also available for loan from the NC Coalition Against Sexual Assault and NC Coalition Against Domestic Violence. • VCR and TV • Handout o Credo for Support STEPS: 1. Set up the video for viewing. Introduce the video. • Credo of Support was written by Norman Kunc. It was written in honor of Tracy Latimer, a girl who had cerebral palsy. Tracy was killed by her father when she was thirteen years old. He decided that her life with a disability was not worth living. 2. View the video. 3. Discuss the video with participants. • What are some key points you’ve learned that you will want to remember when working with clients with disabilities? • Did someone hear a strategy named in the video that they had not thought of?
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CREDO FOR SUPPORT Throughout history, people with physical and mental disabilities have been abandoned at birth, banished from society, used as court jesters, as exhibits in freak shows, drowned and burned during the inquisition, gassed in Nazi Germany, and still continue to be segregated, institutionalized, tortured in the name of behavior management, abused, raped, euthanized and murdered. For the first time communities are being asked to welcome people with disabilities as fully contributing citizens. The danger is that we will respond with remediation or benevolent condescension rather than equity and respect. And so, we offer you A Credo for Support. Do Not see my disability as the problem. Recognize that the real problem confronting people with disabilities is social devaluation, prejudice and oppression. Do Not see my disability as a deficit. Recognize that my disability is an attribute, and that I am a member of the diverse human community. Do Not try to fix me because I am not broken. Support me so I can make my contribution to the community in my way. Do Not see me as your client, for I am your fellow citizen. See me as your neighbor, and remember that none of us can be self-sufficient. Do Not try to modify my behavior. Be still and listen. What you define as inappropriate may be an attempt to communicate with you in the only way I can. Do Not try to change me, you have no right. Help me learn what I want to know. Do Not try to be a competent professional, you will invariably do me harm. Be a person who cares, who takes time to listen, and does not take my struggle away from me by trying to make it all better. Do Not use "pedagogical approaches" on me. To abdicate personal responsibility for your actions behind theories and strategies is pure cowardice. Be with me. And when we struggle with each other let that be the impetus for self-reflection. Do Not try to control me. I have a right to my power as a person. What you call non-compliance or manipulation may actually be the only way I can exert some control in my life. Do Not teach me to be obedient, submissive and polite. You do me no favor. I need to feel entitled to say No if I am to protect myself. Do Not be charitable towards me. The last thing this world needs is more Shriners or another Jerry Lewis. Be my ally as I fight those who exploit me for their own gratification. Do Not try to be my friend. I deserve more than that. Get to know me. We may become friends. 69
Do Not help me, even if it does make you feel good. Ask me if I need your help. Respect my "No" or let me show you how you can best assist me. Do Not admire me. A desire to live a full life does not warrant adoration. Respect me, for respect presumes equity. Do Not tell, teach and lead. Listen, Support and Follow. Do Not work on me. Work with me. Written and Produced by Norman Kunc and Emma Van der Klift Copies available through: Axis Consultation & Training 4623 Elizabeth Street Port Alberni, B.C. V9Y 6L8 Phone (604) 723-6644 Fax (604) 723-6688
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MODULE 3 ALL ABOUT ACCESS
INTRODUCTION AND OVERVIEW ACTIVITY 1: Is Your Agency Accessible? ACTIVITY 2: Accessible Print Materials ACTIVITY 3: Where Do We Go from Here?
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MODULE 3 ALL ABOUT ACCESS INTRODUCTION AND OVERVIEW TIME: 5 minutes BACKGROUND: Taking a few minutes to set the stage for training makes for a smoother training experience. This Introduction and Overview provides the opportunity to state the goal of the training, give an overview of the content, explain the roles of the facilitators and participants, and agree on group guidelines. OBJECTIVES: At the end of this activity, participants will have: 1. Learned the goal of training and reviewed the agenda. 2. Understood their roles and the role of the facilitator(s). 3. Agreed on group guidelines. MATERIALS: • Flip Chart • Marker STEPS: 1. Welcome participants and give an overview of the training. You may want to write down the Goal and the Agenda and post them in the room. •
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Goal: The goal of our training session is to learn about accessibility of services for persons with disabilities, to assess accessibility, and to learn strategies to improve access for people with disabilities who seek services from domestic violence and sexual assault programs. Overview/Agenda: Our agenda for this session includes the following activities: 1. “Is Your Agency Accessible?” during which we’ll use a checklist to assess this facility for accessibility; 2. “Accessible Print Materials”, which looks at accessibility of written materials such as brochures; and lastly, 3. “Where do we go from here?” in which we’ll think about what we can do to enhance our work with people with disabilities. Roles: This room is full of people with a wealth of ideas and experiences. We want you to share them. Your role is to participate actively. The role of the facilitator is to guide discussion and emphasize important take-home messages.
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Guidelines: Let’s look at these sample Group Guidelines. Does anyone want to add to this list? Does everyone agree to follow these guidelines during our training time together? Group Guidelines Start and end on time. Respect others’ opinions. Ask for clarification. Create a safe place for expression. Share your own experiences. Maintain confidentiality. Members participate in all phases of the process as they choose.
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ACTIVITY 1 IS YOUR AGENCY ACCESSIBLE? TIME: 65 minutes BACKGROUND: Agencies are encouraged to conduct an internal assessment of their buildings, programs, and services to evaluate their level of accessibility. When looking at accessibility, agencies should think broadly to include removing structural barriers, as well as communication, attitudinal, and informational barriers. There are many low and no cost ideas and items that can make your agency more functional and friendly to persons with disabilities. The following activity is meant to be a place to begin. Incorporating some of these ideas and practices into your program will help make accessible practices a part of “business as usual.” Accessibility will benefit everyone. The clients you serve, staff, volunteers, and the overall agency will have the opportunity to participate in an inclusive community that is dedicated to quality service. OBJECTIVES: At the end of this activity, participants will have: 1. Identified possible agency barriers that persons with disabilities may face. 2. Examined types of accommodations that can make an agency more friendly and accessible to persons with disabilities. 3. Learned about the Americans with Disabilities Act. MATERIALS: • Handouts, one per participant o Accessibility within Domestic Violence and Sexual Assault Agencies o Removing Barriers to Domestic and Sexual Violence Services: An Abbreviated Accessibility Survey o Plan of Action Form for Improving Accessibility o Simple Accommodations o Suggestions For Your Agency To Support Accessible Practices o Resources on Accessibility • Flip Chart paper • Marker • Pencils • Clipboards STEPS: 1. Write “Accessible” on the flip chart. 2. Brainstorm with participants what an accessible domestic and sexual violence agency would be like. Record their ideas on flip chart. • What comes to mind when you think about accessibility at your agency? • Name some characteristics of an accessible agency. • Why is it important to be accessible? Who would benefit? 74
Points to include: • An accessible agency includes a broad view of the areas of services: o Physical/structural environment (parking lot, building entrance, inside all the rooms); o Information and materials you give to clients (pamphlets, flyers); o Communication (telephones, Relay NC, TTY, assistive listening device, sign language interpreters); o Staff and volunteers’ attitudes about disability. • The Americans with Disabilities Act (ADA) requires domestic and sexual violence agencies to make reasonable accommodations as necessary to make their facilities, services, or programs accessible to people with disabilities. • An accessible program will benefit clients, staff, and volunteers with disabilities; and it also makes the environment and services user-friendly for everyone. 3. Explain briefly the Americans with Disabilities Act (ADA). Give Accessibility within Domestic Violence and Sexual Assault Agencies handout to participants. • The Americans with Disabilities Act (ADA) is a civil rights law passed in 1990 to guarantee equal opportunity for individuals with disabilities in employment, public accommodations, transportation, government services, and telecommunications. • The ADA is consumer driven. There is no current monitoring of compliance or education system in place. This act gives consumers with disabilities the right to request accommodations or file a complaint, if desired. • A reasonable accommodation is defined as a modification or adjustment to structures, policies, programs, or services that enables the right to equal benefits and privileges for individuals with and without disabilities. Agencies should be prepared to reasonably accommodate individuals with disabilities and make necessary modifications that do not require a fundamental alteration of the program. • An agency must provide reasonable accommodations upon request unless it would clearly be an “undue financial burden” on the agency to do so. • The ADA does not guarantee: o That people with disabilities will participate in programs; or o That an organization will be able to provide quality services that adequately meet the needs of people with disabilities. Example: A person using a wheelchair is seeking services from a counseling center. The center is not physically accessible, and the staff offers to schedule a time to meet the person at an accessible office a block away. The person declines, insisting that a ramp be built at the office. In this case, the center has complied with the ADA, and the person with the disability has declined the service. 4. Explain the Removing Barriers to Domestic and Sexual Violence Services: An Abbreviated Accessibility Survey. Give one to each participant. • This is a tool that can guide us to learn more about the accessibility of this agency. With the information you learn, you can begin to find ways to improve 75
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accessibility of your agency for all clients. This survey is not meant to be discouraging. Notice how the survey is divided into sections that assess the physical environment, information, communication, attitudes, and policies of the agency. The survey provides boxes and space to note your findings and make suggestions for accommodations.
5. Divide participants into several groups, so that groups of 5 or less participants can work together on assessing an area of the agency. 6. Assign each group several sections from the accessibility survey to complete (i.e., Group 1 assesses sections 1 and 3, Group 2 assesses sections 4 and 6, etc.). • Each group needs to identify one person to read each question, one person to record the observations, and one person to report the findings to the larger group. • Instruct each group to go to their assigned area (parking lot, for example). • Participants read each question in the assigned section and record general observations, not findings based on specific measurements. (They do not have enough time to take specific measurements.) • In each survey section, the group chooses one item that demonstrates how their agency is currently being disability-friendly and one item that their agency could change to become more accessible. Participants should attempt to complete the survey from the perspective of someone who is deaf or hard of hearing, has vision loss, uses a wheelchair/other assistive device for mobility, or who has a cognitive disability. 7. Allow 15 minutes for groups to go to various areas in the agency and complete their assessments. 8. When assessments are completed, have groups come back together to report and discuss their findings. • What did you observe/learn about accessibility of this agency? • What were some accessible components already in place? Share one. • What barriers did you identify? Share one. • Suggest some accommodations that would reduce these barriers. • What accommodations seem easy to do, and which seem difficult or not feasible at this time and why? • Who would need to be involved to make these kinds of changes? • What accommodations could be put on your agency’s wish list? 9. For additional information, give participants the following handouts: • Plan of Action Form for Improving Accessibility • Simple Accommodations • Suggestions For Your Agency To Support Accessible Practices • Resources on Accessibility
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10. Encourage agency staff to use what they have learned from this accessibility survey to move towards creating a more accessible agency. The Plan of Action Form (see attached) is a useful tool to set priorities and then identify immediate, short-term, and long-term goals for improving access. NOTE TO TRAINERS: This activity reviewed the accessibility of your agency’s office space. If your agency provides shelter services, we strongly encourage you to also review the accessibility of the shelter, as this is a critical location for people with disabilities to be able to access in time of crisis.
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ACCESSIBILITY WITHIN DOMESTIC VIOLENCE AND SEXUAL ASSAULT AGENCIES The ADA outlines 4 priority areas of physical access for existing buildings: 1. 2. 3. 4.
Accessible entrance to the facility Access to goods and services Access to restrooms Any other measures necessary
The Americans with Disabilities Act (ADA) establishes a clear and comprehensive prohibition of discrimination on the basis of disability. The ADA guarantees equal opportunity for individuals with disabilities in employment, government services including transportation, public accommodations, and telecommunications. The law requires agencies to make reasonable modifications as necessary to make the facilities, services, or programs accessible to people with disabilities. A reasonable accommodation is defined as a modification or adjustment to structures, policies, programs and services that enable the right to equal benefits and privileges for individuals with and without disabilities. Although each person who has a disability may have unique needs in order to access services, crisis agencies should be prepared to reasonably accommodate individuals with disabilities, and make necessary modifications that do not require a fundamental alteration of the program. The same services should be available to all people regardless of physical, sensory, cognitive, mental health, multiple, or other disabilities. It is not acceptable to screen for a disability in order to deny services to a person with a disability or a parent who has a child with a disability. An agency must provide reasonable accommodations upon request unless it would clearly be an "undue financial burden" on the agency to do so.
The ADA prohibits discrimination against Americans with disabilities in these 5 areas: TITLE 1 – EMPLOYMENT Responsibility includes making reasonable accommodations in the work environment. Covers all state and local government employers and private employers with 15 or more employees. TITLE 2 - STATE AND LOCAL GOVERNMENTS Responsibility includes removing physical barriers, providing effective communication, and modifying existing policies. Covers government services such as public schools, public libraries and public transportation.
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TITLE 3 – PRIVATE ENTITIES/PUBLIC ACCOMMODATIONS Responsibility includes removing physical barriers, providing effective communication, and modifying existing policies. Includes privately-owned entities such as restaurants, hospitals, hotels, and recreational facilities. Public accommodations include social service organizations such as domestic violence and sexual assault agencies. TITLE 4 – TELECOMMUNICATIONS Telephone companies are required to provide telecommunication relay services for people who have hearing loss or speech limitations. Opportunities for communication must be equivalent to those provided to other customers. Television access requires federally funded public service announcements to be closed-captioned. TITLE 5 – MISCELLANEOUS PROVISIONS Among other issues, Title 5 addresses the ADA’s relationship to other laws and requirements relating to the provision of insurance, regulations by the Access Board, and provision of technical assistance by federal agencies. For technical assistance, information and materials regarding ADA compliance, and referrals to regional resources for individual assistance, please contact your regional technical assistance center. Southeast Disability & Business Technical Assistance Center 1-800-949-4ADA or 1-800-949-4232 (V/TTY) 404-385-0641 (fax)
[email protected] and www.sedbtac.org Crisis agencies should consider adopting an "ADA Compliance Policy" that describes their commitment to provide accessible services/accommodations for people with disabilities. To accommodate persons with disabilities and to comply with the law, it may be necessary to amend or create new agency policies, procedures, and practices. Creating guidelines for exceptions to standing rules may also be needed.
RECOMMENDATIONS FOR MAKING DOMESTIC VIOLENCE AND SEXUAL ASSAULT PROGRAMS AND SERVICES AVAILABLE AND MORE ACCESSIBLE FOR INDIVIDUALS WITH DISABILITIES
Physical Accessibility •
• • •
The building's entrance, doorways, hallways, restrooms, and areas where services are delivered (including residential services - at least one restroom, bath, sleeping area) are physically accessible (widened to at least 36") and kept clear of objects or furniture that could pose barriers for persons who use a wheelchair, cane, or other mobility devices. Tables, chairs, display racks, counters, and other furniture are rearranged if needed to remove obstructions to accessibility. There are accessible parking spaces located closest to the accessible entrance. The building has a ramp or non-step entrance; curb cuts are available at sidewalks and entrances. 79
• • • • • •
Accessible handles or levers (operable with a closed fist) are installed on doors. Raised letters or Braille are included on signs within the building and elevator control buttons. Sections of high tables or counters are lowered for physical accessibility. At least one restroom is equipped with grab bars, adequate space for a wheelchair, and access to the sink (including levers on the faucets). Accessible play areas and counseling are available for children with disabilities if the agency offers children’s services. Alarms have flashing lights and audible sounds.
Counseling • If accessible transportation is not available, a counselor should be allowed to visit a group home, state school/hospital, or other institution to provide individual or group counseling. • Additional time or counseling sessions are allowed for clients with disabilities if needed. • Offer flexibility/patience in goal planning with persons who have difficulty articulating/determining their goals and needs. Communication • Hire sign language interpreters or contract with an interpreter service to facilitate clear communication for intake and counseling sessions for clients who use sign language as a primary means of communication. • Offer agency materials in alternate formats (large print, simplified language, audio cassette, diskette). • Assist clients needing help with correspondence, completing forms, or making telephone calls. • Ensure that a telephone is equipped with a TTY (telecommunication device for the deaf) and that staff/volunteers receive adequate training on TTY use and are familiar with relay services (operator-assisted service allowing communication between a TTY user and a non-user). • Have a telephone with volume control for clients who are hard of hearing. General • Allow service animals within the agency. These animals are not pets, but are specifically trained to assist with mobility, tasks, or alerts. Agency directors, in consultation with the individual, should determine the best way to provide services for the individual and her/his animal in a manner that will be the least disruptive to the other agency clients. • Community education and outreach services are targeted to people with and without disabilities. • Staff and volunteer training includes various aspects of disability and disability resources. • Efforts are made to actively recruit staff and volunteers with disabilities. 80
• • •
Volunteer opportunities are accessible for people with disabilities (i.e., training materials available in alternate formats, training sessions held in physically accessible locations.) Accessible transportation is available for clients with disabilities needing services. Agency fundraising events are held in accessible locations.
CONSIDERATIONS WITHIN SHELTER SETTINGS • • • •
• • •
During intake, ask the individual to identify their needs as well as assistance they prefer. Clients who have a mental health diagnosis (such as schizophrenia) or who experience mental health episodes are not automatically referred to a psychiatric facility (unless they are a danger to themselves or others). Include a line item in agency's budget to hire sign language interpreters when needed. Adopt and implement a policy to allow a client’s personal care assistant to come to the shelter to provide services (as long as the person is not the batterer). Personal care services might include assistance with bathing, dressing, meal preparation or reading. Adapt agency rules (i.e., extend personal phone time for persons who use a TTY or allow persons who have current mental health concerns to have their own bedroom). Modify list of physical chores to include less strenuous tasks that individuals with disabilities may perform. Add non-physical tasks to the chores clients may perform in exchange for services (i.e., meal planning, helping with inventory). Shelter clients who take prescribed medications may need reminders about following doctor's orders.
The Americans with Disabilities Act (ADA) does require reasonable accommodations upon request but does not require program modification(s) that would fundamentally alter the nature of services. Please note that following these recommendations does not guarantee that all accessibility issues are being adequately addressed.
Adapted from Disability Services ASAP (A Safety Awareness Program) of SafePlace, Austin, Texas, 2002.
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REMOVING BARRIERS TO DOMESTIC AND SEXUAL VIOLENCE SERVICES AN ABBREVIATED ACCESSIBILITY SURVEY
Agency: ____________________________ Observer: ____________________ Date:________ The following checklist is intended to assist you in providing services to persons with disabilities. As you tour your facility please answer the following questions with a Yes or No. Additional space for comments and notes is provided below each section. Please note that a YES does not guarantee that accessibility is being adequately addressed. This survey is intended to help you begin a review of your facility’s accessibility and develop plans for improved access. 1. CUSTOMER SERVICE • Do staff / volunteers receive training in providing services to persons with disabilities? Yes No •
Are sign language interpreters provided, if needed? Yes No
•
Do staff / volunteers know how to request sign language interpreters? Yes No
• Are key organizational materials available in alternate formats (audio, large print, or diskette)? Yes No • Does staff know how to obtain or develop alternate formats? Yes No • Do agency materials provide information about services for individuals with disabilities? Yes No • Are assistive listening devices available? Yes No • Does staff / volunteers know how to provide accessible accommodations? Yes No Notes on customer service:
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2. POLICIES • Does the agency have a policy of inclusion that advocates for services that are accessible to all people? Yes No •
Does the agency have an “ADA Compliance Policy” that describes the agency’s intention and commitment to meet the mandates of the ADA? Yes No
•
Does the agency have a policy that allows service animals to accompany their owners? Yes No
•
Does the agency have a policy that allows a person with a disability to be accompanied by her personal care attendant, if needed? Yes No
Notes on policies:
3. EMERGENCY PROCEDURES • Do fire alarms provide visual and audible signals? Yes No •
Are there fire alarms with visual and audible signals in restrooms, meeting rooms, hallways, lobbies, and other common areas? Yes No
● Are evacuation maps of adequate size, height and contrast posted in restrooms, hallway, reception area, and other common used areas? Yes No •
Are fire extinguishers stored at a reasonable height for someone using a wheelchair or of small stature (48” or less)? Yes No
•
Do emergency procedures require staff to visually check all facility areas to ensure all clients are aware of the emergency announcement? Yes No
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•
If there is more than one floor, is there an agency plan for evacuation of persons with disabilities from floors above the first floor? Yes No
•
Is there an evacuation chair on site? Yes No
•
If yes, is staff aware of the chair’s location? Yes No
•
If evacuation chair is available, does staff know how to use this equipment? Yes No
•
Has staff received training regarding emergency procedures for persons with disabilities? Yes No
Notes on emergency procedures:
4. TELEPHONE CONTACTS • Is a TTY (text telephone) available? Yes No •
If a TTY is available, do volunteers and staff know how to use it? Yes No
•
Do staff / volunteers know how to use NC Relay? Yes No
Notes on telephone contacts:
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5. PARKING • Is a TTY (text telephone) available? Yes No •
Is one in every eight accessible spaces van accessible (min. 8’ wide + 8’ hatch)? Yes No
•
Do accessible spaces have appropriate signage? -Accessible symbol Yes -$250 fine Yes
•
Is there an adequate number of accessible parking spaces? *see below Yes No
•
No No
Are accessible spaces the closest spaces to the building (recommended not to exceed 200 ft. from the accessible entrance)? Yes No
•
Do accessible parking spaces allow people to get in and out on a level, smooth surface? Yes No
•
Does the person using the accessible space have to navigate behind parked cars to enter the building? Yes No
•
Is there a curb cut to the sidewalk? Yes No
•
If yes, is the curb cut kept clear? Yes No
*(For every 25 spaces, at least one must be accessible. For 501-1000 spaces, 2% should be accessible. For more than 1000 spaces, at least 20 must be accessible + one for each 100 spaces over 1000). Notes on parking:
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6. TRANSPORTATION • Does your community have accessible public transportation? Yes No If yes, what types of transportation services are available? _________________________________________________________________________ •
Do accessible public transportation services serve the agency’s location? Yes No
•
Does your community have paratransit services (for people who can not use typical public transportation)? Yes No
•
Can persons with disabilities access bus services from the agency (clear path of travel, close distance, and accessible bus)? Yes No
•
Are the transportation vehicles (bus or van) equipped with a lift for persons who use a wheelchair? Yes No
Notes on transportation:
7. CIRCULATION PATHS* AND ENTRANCES • Are the paths of travel: -At least 36” wide? Yes Yes -Level? -Smooth? Yes
No No No
•
Are the paths free of permanent obstructions? Yes No
•
Are the paths free of temporary obstructions? Yes No
•
Do routes have adequate passing space (60” diameter circle or a T-shaped space)? Yes No
•
If a flight of stairs is present, does it have: -Handrails on both sides?
Yes
No 86
-Extensions on the top and bottom?
Yes
No
•
If there are steps, do steps have contrast edge marking? Yes No
•
If there is a ramped entry, does it have 1:12 slope or less? Yes No
•
If the ramp is longer that 6 ft., does it have sturdy railings on both sides that are between 34” & 38” high? Yes No
•
Can doors be opened with hardware that does not require grasping, pinching, or twisting? Yes No
•
Are the exterior doors heavy and difficult to open? Yes No
•
Is there an automatic door option? Yes No
•
Are the internal doors heavy and difficult to open (>5lbs.pressure)? Yes No
•
Are the doorways wide enough to access when using a wheelchair or scooter (32” of clear opening space)? Yes No
•
Where carpeting or rugs are used, are they permanently affixed to the floor surface? Yes No
•
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DVD’s For Law Enforcement, First Responders, and Advocates on Disabilities
Autism Awareness for Law Enforcement and Community Service Personnel .autismsociety-nc. Credo www.qualitymall.org Disability Awareness for Law Enforcement .ilea. End the Silence .disabilities.temple. Law Enforcement: Your Piece To The Autism Puzzle www.saharacares.net Project G.U.I.D.E. Communicating Effectively with Victims/Witnesses with Severe Disabilities (Barbara Wheeler, University of Southern California UCEDD at Children’s Hospital Los Angeles 323-669-2300,
[email protected]) Serving Crime Victims With Disabilities .ojp.usdoj.gov/ The Mirror Cracked: How to Recognize Exploitation, Neglect & Abuse .disabilityrightsnc. To Protect and Serve: An Introduction to People with Intellectual Disabilities .arcnc. Victims with Disabilities: Collaborative, Multidisciplinary First Response (March 2009) .ovc.gov/publications Victims with Disabilities: The Forensic Interview-Techniques for Interviewing Victims with Communication and/or Cognitive Disabilities (April 2007) .ovc.gov/
Martha Lamb, 2009 Justice Systems Innovations
Sexual Violence Awareness Fact Sheet People with Disabilities
Overview The Americans with Disabilities Act defines a mental health disability as “a mental impairment that substantially limits one or more major life activities”, such as self-care, learning, working, or performing manual tasks. The disability may or may not be related to a person’s experience of sexual violence. Numerous nationwide studies consistently show prevalence rates of sexual abuse histories at 50-70% among women in inpatient psychiatric facilities. On Record: Facts about Mental Health & Physical and Sexual Abuse. 1994. U.S. Department of Health and Human Services, Center for Mental Health Services.
The total annual cost of mental health care for victims of attempted or completed rape is estimated at $863 million. Victim Costs and ConsequencesA New Look 1996. Ted R. Miller, Mark A. Cohen, Brian Wiersama. U.S. Dept. of Justice, Office of Justice Programs, National Institute of Justice.
Almost 1/3 (31%) of all rape survivors develop Posttraumatic Stress Disorder (PTSD) sometime during their lifetimes. Rape in America: A Report
to the Nation. 1992. National Victim Center and Crime Victims Research and Treatment Center, University of South Carolina, Charlestown.
Women with disabilities are raped and abused at a rate at least twice that of the general population of women. Sobsey, D. 1994. Violence and Abuse in the Lives of People with Disabilities: The End of Silent Acceptance. Baltimore, MD: Paul H. Brooks Publishing Co, Inc.
These statistics clearly show that people with mental health disabilities experience sexual assault at a very high rate, and often are victimized by someone they know and trust. Yet, due to a variety of factors, it is often difficult for them to get the services they need. It is critical that sexual violence victim advocates in Virginia understand the needs and barriers of people with mental health disabilities so they can provide appropriate and sensitive outreach and services to this community. Note: There has been very little research done in the area of people with mental health disabilities and sexual violence, particularly in recent years, making it difficult to provide current statistics.
Support for this fact sheet provided by Virginia Department of Criminal Justice Services Grant 05-F3476SA04 and Office on Violence Against Women-Sexual Violence Grant 2004-SWAX0060.
Ableism Belief: I am not qualified to work with survivors of sexual violence who have a mental health disability. Truth: Advocacy can be effective whether or not someone has a mental health disability.
Beliefs about mental health disabilities can make it more difficult for sexual assault survivors with mental health disabilities to access and receive appropriate services if they have experienced sexual violence. They may fear being stereotyped based on these myths, or they may have internalized the myths and believe these things are true themselves. As advocates, it is important to understand when ableism prevents us from providing appropriate services.
Belief: I am not/My program is not qualified to work with survivors of sexual violence who have a mental health disability. Truth: Advocacy can be effective whether or not someone has a mental health disability. Your training and professional experience have equipped you to address their experience of sexual violence.
Belief: Advocates cannot address the sexual violence a person has experienced until the person’s mental health disability is addressed. Truth: As is the case with all survivors, it is important that those with mental health disabilities decide when they are ready to address their experience of sexual violence. The survivor knows best when s/he is ready and how s/he wants to go about receiving support. Also, the mental health disability may be due to or aggravated by an experience of sexual violence, so addressing the sexual violence can be a critical component of treating the symptoms of a mental health disability.
Belief: People with mental health disabilities are not capable of participating in their own healing process. Truth: People with mental health disabilities are capable of engaging and participating in their own healing process. This can be achieved most readily when the person is supported and empowered by an advocate who is focusing on her or his strengths and ability to heal rather than on her or his limitations.
Barriers Lack of access to services
People with mental health disabilities may be segregated from the general public in education, employment, or housing, which limits their participation in common social settings. Therefore, people with mental health disabilities are often not aware of community services that are available to them after an assault, such as medical and legal services, victim advocacy, and counseling. Make sure that brochures and resources about local services are available at a variety of places used and visited by people with mental health disabilities, including local Centers for Independent Living, community service boards, and the offices of service providers. Provide training and build relationships with local programs that help people with mental health disabilities. Continue to do outreach to these communities so they are aware of the services that you provide.
Stigma and prejudice The stigma generally associated with mental health disabilities may greatly decrease the perceived credibility of the victim. Further, previous experiences or awareness of prejudice against people with mental health disabilities can make it even more difficult for survivors with mental health disabilities to speak out about abuse. When a survivor of sexual violence is not believed or is viewed as not credible, it reinforces that person’s sense of isolation, self-doubt, and reluctance to report or seek help after an assault. Let the survivor know that you believe her or him and that you support her or him. Provide positive reinforcement and advocate on her or his behalf, when appropriate, if s/he is being treated differently because s/he has a mental health disability.
Lack of awareness among responders A lack of education, training, and awareness in mental health issues for advocates, law enforcement and other responders to sexual assault could result in inappropriate services and/or referrals. For example, when crimes are reported to authorities, they may be considered incidents of abuse and neglect, not as crimes, and as such may be handled by group homes and institutions administratively, rather than going through the law enforcement system or referring the victim to an advocate. Provide training and resources to all responders to sexual violence. Educate them on issues of sexual violence and work with local mental health providers to educate responders on mental health issues. Continue to follow up so that these responders know when and who to contact if they suspect sexual assault.
Limited resources to accommodate needs The limited resources of non-profit and state agencies responding to sexual assault make it increasingly difficult to provide safe and appropriate services and/or accommodations for people with mental health disabilities. Consider forming partnerships with local disability service providers to serve people with mental health disabilities victimized by sexual assault in a continuum of service. These partnerships could reduce the time-intensive nature of responding to a person who has been sexually assaulted and who also has a mental health disability, while still providing the best care.
When a survivor of sexual violence is viewed as not credible, it reinforces that person’s sense of isolation, self-doubt, and reluctance to report or seek help after an assault.
Helping
What Crisis Centers Can Do to Make a Difference Provide all survivors a safe place to address their experiences of sexual violence. Ask the survivor what accommodations or resources would be helpful to her/him. Have an understanding of how service systems designed to help people with mental health disabilities work. Have an understanding of the barriers that people with disabilities face every day. Understand and respond to an individual’s need rather than relying on stereotypes or preconceived notions to determine the services needed. Address the issues of sexual violence using your advocacy skills and make appropriate referrals as needed to help the survivor receive appropriate services for her or his mental health disability. Work together with allied professionals to expand the availability of services available to victims with mental health disabilities. Build partnerships with human services community groups, Centers for Independent Living, mental health professionals, substance abuse treatment facilities, law enforcement, Commonwealth’s Attorneys, and medical personnel in order to best help individual survivors and end the isolation of this large number of “silent” victims.
Resources Non-offending family support can be a very powerful way to encourage people with mental health disabilities. Just knowing that they are cared for and have someone they can go to for support can make all the difference to their over all well-being. National Alliance for the Mentally Ill (NAMI) provides support, education, advocacy and research on mental illness to mental health consumers, families, and friends of people with severe mental illnesses, such as schizophrenia, major depression, bipolar disorder, obsessive-compulsive disorder, and anxiety disorders. www.nami.org Community services boards may provide counseling and case management for people with mental health disabilities. www.vacsb.org Local consumer-managed mental health support groups provide peer support and often can encourage and give moral support to one another in ways that people without a mental illness could not do. www.vocalsupportcenter.org National Mental Health Consumers Self-Help Clearinghouse connects individuals to self-help and advocacy resources, and offers expertise to self-help groups and other peer-run services for mental health consumers. www.mhselfhelp.org Virginia Sexual and Domestic Violence Action Alliance (VSDVAA) provides training, technical assistance and resources for advocates and allies on working with people with mental health disabilities. VSDVAA also promotes and supports collaborations among the different service providers and responders who work with people with mental health disabilities who are victims of sexual violence. www.vsdvalliance.org
1010 North Thompson Street, Suite 202 • Richmond, VA 23230 Phone: 866.3.VSDVAA • Virginia Family Violence & Sexual Assault Hotline: 1.800.838.8238 (v/tty)
Traumatic Brain Injury and Domestic Violence: Understanding the Intersections This Special Collection offers information about the intersection between domestic violence and Traumatic Brain Injury (TBI). It provides advocates and other professionals with tools to screen for TBI within the context of domestic violence as well as presentations, articles, and other relevant resources on the topic. The purpose of this collection is to: 1) increase knowledge and understanding of TBI within the context of domestic violence, 2) provide tools to advocates and other professionals to screen domestic violence survivors for TBI, and 3) highlight best practices. The NRCDV provides a wide range of free, comprehensive, and individualized technical assistance, training, and specialized resource materials and projects designed to enhance current intervention and prevention strategies. To suggest additional resources we should include in this collection or for ongoing technical assistance and other resources, please contact the NRCDV Technical Assistance Team at 800-537-2238 (ext 5), TTY: 800-553-2508, @pcadv.org, or via our TA form. Table of Contents • •
•
• • •
the Intersection: TBI and DV o Information o Tools o Materials o Services & Accommodations Issues o Violence and the Military o and Children & Products for Purchase
Introduction A traumatic brain injury (TBI) is defined as a specific type of damage to the brain that is caused by external physical force and is not present at birth or degenerative. A blow (or blows) to the head, shaking of the brain, loss of oxygen (anoxia), colliding with a stationary object and exposure to blasts can cause a TBI. Based on this definition, the use of physical force by an intimate partner during incidents of domestic violence can cause traumatic brain injury as abusive partners often cause injury to a victim’s head, neck (including strangulation), and face. In one study, 30% of domestic violence survivors reported a loss of consciousness at least once and 67% reported residual problems that were potentially head-injury related ( , Wolfe, Mysiw, Jackson & Bogner, 2003). However, TBI often goes undiagnosed amongst domestic violence survivors. One reason for this is that domestic violence survivors, who also have a TBI, may exhibit symptoms that could resemble those of a mental illness, such as depression, anxiety, tension and/or inability to adapt to changing situations. Additionally, DV/TBI survivors may appear to have behavioral issues, including problems with keeping appointments, following through, or completing tasks that require multiple steps. Anecdotal information from survivors and advocates indicates that victims with TBI are often questioned in regards to their ability to parent. At a training for domestic violence advocates, a TBI survivor as a result of domestic violence shared how she would forget to pick up her daughter from
school, which prompted a call to the Child Protective Services agency in her area. Others have talked about the difficulties they experienced while living in congregate settings where following rules was, at times, problematic. These kinds of behaviors are often not intentional and survivors may even appear to be uncooperative and oppositional. However, it is important to keep in mind that many of these perceived behaviors might be directly related to the TBI. Therefore, it is crucial for domestic violence service providers and health care professionals to understand the prevalence and effects of TBI within the context of domestic violence. This collection offers screening tools for advocates in the field of domestic violence as well as other relevant information for recognizing when the person they are supporting has a TBI.
Understanding the Intersection: TBI and DV This section explores the intersection between TBI and DV. A screening tool for TBI adapted by domestic violence service providers is included, along with several other related resources available for download. "Women who are abused often suffer injury to their head, neck, and face. The high potential for women who are abused to have mild to severe Traumatic Brain Injury (TBI) is a growing concern, since the effects can cause irreversible psychological and physical harm. Women who are abused are more likely to have repeated injuries to the head. As injuries accumulate, likelihood of recovery dramatically decreases. In addition, sustaining another head trauma prior to the complete healing of the initial injury may be fatal." - Excerpted from the Screening Tool for Traumatic Brain Injury adapted and developed by the New York Coalition Against Domestic Violence. Posted below with permission. General Information •
Domestic Violence and Traumatic Brain Injury Tip Card (1 p.) by Brain Injury Association of Virginia This tip card provides information on one of the most unrecognized consequences of domestic violence, encouraging family members, friends, and professionals to be aware of the causes and long-term consequences of TBI. [ Info]
•
The Domestic Violence/TBI Intersection (1 p.) by National Association of State Head Injury Administrators This webpage provides information about the intersection between TBI and DV. It also lists national anti-violence organizations and resources. [ Info]
•
Increasing Awareness about Possible Neurological Alterations in Brain Status Secondary to Intimate Violence (30 p.) by Mary Car, Brain injury Association of America This paper explains the possible types and etiologies for traumatic injuries, neurochemical changes and structural alterations that may occur in the brain as a result of intimate violence, most of which are not being diagnosed. [ Info]
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Traumatic Brain Injury and Domestic Violence Facts (2 p.) by Alabama Coalition Against Domestic Violence This fact sheet provides frequently asked questions and answers about TBI and DV as well as screening tips. [ Info]
•
Traumatic Brain Injury and Domestic Violence: What do professionals need to know? (17 p.) (1 p.) by New York State Office for the Prevention of Domestic Violence This document provides information and relevant resources for the early detection of TBI among domestic violence survivors. It also offers an analysis of the intersection between brain injury and domestic violence as well as other relevant information. [ Info]
•
Victimization of Persons with Traumatic Brain Injury or Other Disabilities: A Fact Sheet for Professionals (5 p.) by Centers for Disease Control and Prevention (CDC), Department of Health and Human Services (HHS) This fact sheet provides statistics on the extent of the problem and factors that may make a person with a traumatic brain injury, or TBI, susceptible to victimization. [ Info]
Screening Tools •
Brief Screening for Possible Brain Injury (1 p.) by Alabama Department of Rehabilitation Services, Alabama Head Injury Foundation This brief screening tool is used to determine if an individual has experienced a brain injury during the course of a domestic violence incident, or at any other time. [ Info]
•
Traumatic Brain Injury and Domestic Violence: HELPS Screening Tool for Traumatic Brain Injury (7 p.) by New York State Coalition Against Domestic Violence (2006) This document discusses the intersection between DV and TBI, lists symptoms and recommendations for working with survivors with TBI, and offers a screening tool to aid in determining if survivors should be seen by a doctor for further evaluation. [ Info]
Training Materials •
Domestic Violence and Traumatic Brain Injury: Understanding the Intersections Webinar Materials (47 p.) by presented by by Judith Avner and Sarah DeWard for the National Resource Center on Domestic Violence (March 2010) This webinar held on March 24, 2010 explored the intersections between domestic violence and TBI. Presenters shared useful tips for how to best work with DV survivors who have sustained a brain injury. [ Info]
•
Podcast: Domestic Violence and Traumatic Brain Injury (1 p.) by Sarah M. DeWard, Northeast Center for Special Care (November 2008) This podcast discusses domestic violence and its patterns and types of abuse with a focus on individuals who have a traumatic brain injury. Therefore, its intended audience is TBI service providers but this can still be a useful training tool. [ Info]
•
Traumatic Brain Injury and Domestic Violence: A Trainer's Manual (1 p.) (1 p.) by Alabama Department of Rehabilitation Services, with the Alabama Coalition Against Domestic Violence and the Alabama Heal Injury Foundation (2004) This manual includes PowerPoint presentations, speaker notes and instructions, workshop agenda and evaluation material, and handouts regarding screening and
accomodations for individuals with TBI. [ Info] •
Traumatic Brain Injury and Domestic Violence Webcast (1 p.) by Susan L. Vaughn, Sue Parry, and Blanca Kling, National Association of Head Injury Associations (August 2004) This webcast discusses safety planning, screening methods, coping strategies, intervention techniques, resources, services, and supports for victims of domestic violence with traumatic brain injury. [ Info]
•
Understanding Life with a Brain Injury: The crossroads of Traumatic Brain Injury and Domestic Violence (43 p.) by Judith Avner, Esq., Brain Injury Association of New York State (February 2010) This PowerPoint presentation offers information related to the prevalence of TBI and discuses the intersections between TBI and DV. Additionally, it provides specific tips including a screening tool, for DV advocates working with survivors with TBI. [ Info]
Services & Accommodations •
Accommodations for Individuals with Brain Injury (1 p.) by Alabama Department of Rehabilitation Services This checklist suggests accommodations for professionals or family members that would assist in working/supporting individuals with a Traumatic Brain Injury. [ Info]
•
Safety Planning for Victims with TBI (44 p.) by Sue Parry, New York State Office for the Prevention of Domestic Violence (2009) This resource offers information related to safety planning tips for victims of domestic violence with a TBI, including a bibliography and a full PowerPoint presentation on TBI and domestic violence. [ Info]
Related Issues Domestic Violence and the Military The intersection between domestic violence, TBI and the military is an issue of growing concern due to the increase in the number of veterans returning from the wars in Iraq and Afghanistan. As many as 20% of US combat troops leaving these war zones are affected by traumatic brain injury ( Center for Military Health Policy Research, 2008). Considering the potential implications of this problem for the domestic violence field, the NRCDV is currently in the process of developing a separate special collection devoted to this topic that will be posted in the upcoming months. Issues affecting female veterans: Although significant gaps remain in our understanding of how domestic violence-related TBI affect women veterans, were are including the following article to highlight some of the overall issues affecting women veterans. This section of the collection is expected to continue growing as more information becomes available. However, based on the information contained in this article alone, it appears that for female veterans the challenges can be compounded by societal perceptions and stigma.
•
Back from combat, women struggle for acceptance (3 p.) by Kimberly Hefling, Associated Press, AirForceTimes (December 2009)
The article reports, "More than 230,000 American women have fought in those recent wars and at least 120 have died doing so, yet the public still doesn’t completely understand their contributions on the modern battlefield." [ Info] TBI and Children The topic of TBI and children goes beyond the scope of this collection. However, we acknowledge that exposure to domestic violence may result in trauma. In turn, trauma has a significant impact on the biochemistry of the brain particularly during developmental stages in childhood and adolescent years. For more information about the impact of domestic violence on early brain development, see " Effects of Exposure to Intimate Partner Violence in Early Childhood: A review of the literature" by Georgia L. Carpenter and Ann M. Stacks from Volume 31, Issue 8 of the Children and Youth Services Review (August 2009). The article explains: "Experiences in the first few years of life greatly influence brain development and the most influential ways a child's brain develops is through his or her relationships with caregivers. These experiences with caregivers and other aspects of the baby's environment, for example violence in the home, play an important role in social and emotional development and are imperative to investigate when working with infants and caregivers." Children may also be victims of child abuse and suffer head trauma as a result. The most common form of head trauma suffered by children is known as Shaken Baby/Shaken Impact Syndrome or Abusive Head Trauma, caused by direct blows to the head, dropping or throwing a child, or shaking a child. Head trauma is the leading cause of death in child abuse cases in the United States ( , 2009). We have included below some resources that may be useful to the reader when exploring these issues: ChildTrauma Academy, a not-for-profit organization based in Houston, Texas is a unique collaborative of individuals and organizations working to improve the lives of high-risk children through direct service, research and education. Child Witness to Violence Project (CWVP) is a counseling, advocacy, and outreach project that focuses on the growing number of young children who are hidden victims of violence: children who are bystanders to community and domestic violence. It is run under the auspices of the Department of Developmental and Behavioral Pediatrics at Boston Medical Center. Institute for Safe Families (ISF) is a non-profit organization and a nationally acclaimed family violence prevention initiative under the auspices of Physicians for Social Responsibility since the early nineties. The mission of ISF is to prevent intimate and family violence and to promote the health and well being of each member of the family and the community in which they live. ISF also advocates for changes in systems and policies that affect families living with interpersonal violence. Educational and Resources Network (LEARNet) is a project of the Brain Injury Association of New York State and includes a problem solving system to assist users in identifying useful procedures for helping students with brain injury at work and at school. National Center on Shaken Baby Syndrome (NCSBS) is a 501(c)(3) nonprofit organization and is the only worldwide organization that is dedicated solely to the prevention of this form of child abuse. The NCSBS focuses their efforts in two areas: professional training for those who work with
SBS/AHT cases, and prevention education for parents and those who work to prevent child abuse. National Child Traumatic Stress Network was established to improve access to care, treatment, and services for traumatized children and adolescents exposed to traumatic events. National Center for Children Exposed to Violence's (NCCEV) mission is to increase the capacity of individuals and communities to reduce the incidence and impact of violence on children and families; to train and support the professionals who provide intervention and treatment to children and families affected by violence; and, to increase professional and public awareness of the effects of violence on children, families, communities and society. TO THREE is a national nonprofit organization that informs, trains and supports professionals, policymakers and parents in their efforts to improve the lives of infants and toddlers. Neuroscientists have documented that our earliest days, weeks and months of life are a period of unparalleled growth when trillions of brain cell connections are made. Research and clinical experience also demonstrate that health and development are directly influenced by the quality of care and experiences a child has with his parents and other adults. That is why at ZERO TO THREE our mission is to promote the health and development of infants and toddlers.
Bibliography The following articles provide some of the framework and necessary information to better understand the intersections between TBI and DV. This is a bibliographic list that only includes titles and their sources. These articles are copyright protected therefore their contents are not included in this section. They appear as part of this collection to make the reader aware of these valuable resources and act as a supplement to the previous sections. Arosarena, O. A., Fritsch, T. A., Hsueh, Y., Aynehchi, B., & Haug, R. (2009). Maxillofacial injuries and violence against women. Archives of Facial Plastic Surgery, 11(1), 48-52. Corrigan, J. D., Wolfe, M., Mysiw, J., Jackson, R. D., & Bogner, J. A. Early identification of mild traumatic brain injury in female victims of domestic violence. American Journal of Obstetrics and Gynecology, 188(5), S71-S76. Empire Justice Center (2006). Building Bridges: A Cross-Systems Training Manual for Domestic Violence Programs and Disability Service Providers in New York. Albany, NY. Funk, M., & Schuppel, J. (2003). Strangulation injuries. Wisconsin Medical Journal, 102(3), 41-45. Jackson, H., Philp, E., Nuttall, R. L., & Diller, L. (2002). Traumatic brain injury: A hidden consequence for battered women. Professional Psychology: Research & Practice, 33(1), 39-45. Mechanic, M. B., Weaver, T. L., & Resick, P. A. (2008). Risk factors for physical injury among help-seeking battered women. Violence Against Women, 14(10), 1148-1165. Monahan, K., & O'Leary, K. D. (1999). Head injury and battered women: An initial inquiry. Health and Social Work, 24(4), 269-278. Picard, N., Scarisbrick, R., & Paluck, R. (1999). HELPS (Grant # H128A0002). Washington, DC: US Department of Education Rehabilitation Services Administration, International Center for the
Disabled.
Videos & Products for Purchase Domestic Violence and Traumatic Brain Injury: Tool Kit Video (2004) This is a toolkit video for domestic violence service providers. An explanation about the symptoms that DV/TBI survivors may display and some of the interventions to best support them are the main topics presented here. Length: 7.50 Distributor: Alabama Department of Rehabilitation Services Attn. Maria Crowley P.O. Box 19888 Homewood, AL. 35219-0888 Tel: 205.290.4590 Fax: 205.945.8517 @rehab.state.al.us Domestic Violence and Traumatic Brain Injury: Victims' Video (2004) This video was designed for DV survivors. It portraits a DV/TBI survivor telling her story and sharing some of the symptoms and challenges she had to face during her recovery and for most of her life. This survivor also highlights how specific accommodations continue to have a positive impact in her life. Length: 5.10 Distributor: Alabama Department of Rehabilitation Services Attn. Maria Crowley P.O. Box 19888 Homewood, AL. 35219-0888 Tel: 205.290.4590 Fax: 205.945.8517 @rehab.state.al.us Traumatic Brain Injury and Domestic Violence Web Cast by the National Association of State Head Injury Administrators (2004) This Web cast discusses safety planning, screening methods, coping strategies, intervention techniques, resources, services, and supports. Length: 1 CD/120 minutes Cost: $25
Organizations The following organizations provide services to individuals living with a brain injury and/or devote attention and resources to studying the intersections between Traumatic Brain Injury and Domestic Violence. This list is not inclusive by any means, and it is expected to continue to grow over time. If you can suggest an organization that is not currently included here, please feel free to contact the NRCDV's Technical Assistance Team at 800-537-2238 (ext 5), TTY: 800-553-2508, @pcadv.org ,
or via our TA form. Brain Injury Association of America Founded in 1980, the Brain Injury Association of America (BIAA) is the leading national organization serving and representing individuals, families and professionals who are touched by a life-altering, often devastating, traumatic brain injury (TBI). You may access TBI state specific organizations through this website. Center on Domestic and Sexual Violence: Section on military domestic and sexual violence The National Center on Domestic and Sexual Violence (NCDSV) designs, provides, and customizes training and consultation, influences policy, promotes collaboration and enhances diversity with the goal of ending domestic and sexual violence. York State Coalition Against Domestic Violence The New York State Coalition Against Domestic Violence (Coalition) is a not-for-profit membership organization whose mission is to eradicate domestic violence and to ensure the provision of effective and appropriate services to victims of domestic violence through community outreach, education, training, technical assistance and policy development. The Coalition's principles and practices prioritize the safety and concerns of women who are abused, provide support and encouragement for the participation of women who are abused in the struggle to eradicate personal and institutional violence against them, and provide for a non-competitive atmosphere that fosters open communication, respect, and cooperation among advocates and women who are abused. Injury Association of New York State The Brain Injury Association of New York State provides support services to brain injury survivors and their families, programs for those injured before age 22 and for school-age children with brain injury, an array of resources and publications, support groups, among other services.
UNDERSTANDING DEAF VICTIM/SURVIVORS OF DOMESTIC VIOLENCE Terminology used to refer to individuals who are disabled has evolved over the years from such crude references to the Deaf, as "deaf and dumb", to more accurate references as individuals with profound hearing impairments. The Americans with Disabilities Act (ADA) recognized in its title that people with disabilities were persons first, and disabled second. Therefore, to refer to someone as a "deaf person" is not in keeping with ADA terminology. However, it is important that one refer to individuals with disabilities in a way that is acceptable to them. Most often, hearing impaired adults refer to themselves as Deaf and Hard-of-Hearing (HOH), rather than individuals with mild, moderate, or profound hearing impairments. Therefore, throughout this resource page, the terms Deaf and HOH are used. Although it is not customary in writing to capitalize the "D" in deaf, many Deaf persons prefer this as a means of expressing their pride as a member of a sign-language using community or culture. Out of respect for these feelings, Deaf is capitalized throughout this resource page. Service providers should be aware that even though the ADA includes the Deaf and HOH in their group of individuals with disabilities, who qualify for funding, not all persons with hearing impairments consider themselves disabled, nor do they want others to see them in that light.
COMMUNICATION OPTIONS Communication is an important component of everyone's life and possible choices for communication include a variety of symbol systems. For example, one may communicate in English through speaking, writing, listening and reading. Despite these skills, communication with someone whose only language is American Sign Language (ASL) is not possible. In the United States, Deaf people also use a variety of communication systems such as: speaking, *speechreading, writing, electronic and manual communication. Manual communication is a generic term referring to the use of manual signs and fingerspelling. The following is a partial list of communication options available to Deaf and HOH individuals. • •
•
•
Oral Communication - denotes the use of speech, residual hearing and speechreading as the primary means of communication. American Sign Language ( ASL) - is a language whose medium is visual rather than oral. As in any other language, ASL has its own vocabulary, idioms, grammar and syntax. This language consists of handshapes, position, movement, and orientation of the hands to the body and each other. ASL also uses space, direction and speed of movements, and facial expressions to help convey meaning. Fingerspelling - instead of using an alphabet written on paper, a manual alphabet is one with handshapes and positions corresponding to each of the letters of the written alphabet being used. Speechreading - recognizing spoken words by watching the speaker's
lips, face and gestures is a daily challenge for all Deaf people. Speechreading is the least consistently visible of the communication choices available to Deaf people because only 30 percent of English sounds are visible on the lips, while a large percentage are sounds that might sound different but look the same on the lips. Example: Look in a mirror and say words like "kite, height, night, without using your voice. You will see almost no changes on your lips to distinguish among those three words. Or say the words "maybe, baby, pay me" they look exactly alike on the lips. This is not an all-inclusive listing of communication systems available to Deaf and HOH persons. There are a variety of systems of manual communication and within the last decade technology has expanded these options. It is imperative that service providers determine the usual mode of communication employed by each individual and make appropriate accommodations. It is not appropriate to use a pen and a pad of paper as your primary method of communicating with a Deaf/HOH victim. *Speechread, rather than lip-read, is more descriptive since the client is responding to facial expression and body language in addition to reading lips.
DEAF CULTURE AND COMMUNICATION "Culture" may be defined in a variety of ways depending on the perspective of the one defining the term. Language in any culture is important. It is important to recognize that some communication systems used by the Deaf employ different rules. ASL, for example, "is a unique language that has its own grammatical rules and sentence structure. It is every bit as precise, versatile, and subtle as the English language. As a result, unless the service provider is fluent in ASL, valuable information may be misinterpreted or missed all together. The use of an interpreter when the service provider does not sign or is not a skilled signer is essential but must be done cautiously. Effective communication has never been more important than when service providers, counselors, or therapists communicate through interpreters. Even though most service providers may not be proficient signers, they need to become aware of various aspects of Deaf culture and some of the characteristics of ASL communication. When hearing providers adapt their behavior to be more accommodating to Deaf culture, they will be able to provide services more effectively. Here are a sampling of guidelines to consider: How a hearing person should address a Deaf person: Establish eye contact, don't start talking until the eye contact is made, tap on shoulder if needed, etc. Deaf Taking Turns: Folding one's arms while frowning and leaning back is a device used to invite someone to take a turn or to encourage a reticent individual to participate - this could be the opposite for hearing people . A
shrug or open hands indicate one has nothing to say and gives the floor to someone else. Raised eyebrows with a smile or an open mouth ask for a turn when one has a sudden idea or inspiration. Hearing Taking Turns: Hearing people need to understand that only one person should speak at a time. This allows the Deaf person and the Interpreter to receive and provide effective communication. Turning One's Back: As has already been emphasized, maintaining visual contact is essential in ASL. If one wishes to insult another, all one needs to do is turn the head and close the eyes, thus cutting that person off. If someone needs to turn away, they demonstrate a sign with a fist with first finger out to say 'wait'. Then, go back to that person and resume, or tell the person who interrupts to wait until the other person is finish talking. Taking Another's Hand: Although it is acceptable to take another person's hand in greeting or to touch the hands of a person who is not signing, it is extremely rude to take another person's hand to stop them from signing. Sharing Information: Many members of the Deaf community do not attempt to hold private conversations in group settings. Generally, privacy is difficult in sign language. Once a conversation has begun, anyone who wishes, may join in or watch. Privacy can be had, by going behind closed doors. But secrecy, except as a joke, is not considered appropriate in the social setting of the Deaf community and so may be considered rude. Deaf people often think a hearing person's attitude toward privacy is infuriating and perplexing. Hugging: This is a common gesture among Deaf people and is intended only as a greeting or to bid good bye. Saying Goodbye: When a Deaf person finishes a conversation, they must explain where they are going and what they are going to do. The other person will then reciprocate. Conversations are never considered completely over until everyone leaves for the night, at which time people look for their friends to say good night to them. As might be expected, this process can take a long time. People almost always indicate when they will see each other again, sometimes repeating the date and the place several times. Leaving a social gathering too quickly might also deny someone the opportunity to talk to another; so indicating repeatedly that one is about to leave is a way of announcing to friends that if they want to say something they had better do so. Conversational Pattern: Interactions often begin informally and jokingly and end formally and seriously. The pace of conversation is rapid at the beginning - people say hello and get straight to the point - but ending the conversation is a gradual process. Getting to the point and being direct is never rude, as it sometimes is in hearing conversation. Ending abruptly, as is sometimes done in American English interchanges, may be construed to mean that the person ending the conversation does not care about the other person.
This could be one source of hearing people's complaints that Deaf people are too blunt and likewise of Deaf people's feeling that hearing people do not care about them or talk down to them. This section on Deaf culture and communication provides only a small amount of the characteristics of Deaf communication that must be understood by service providers. Culture and communication are dynamic. Consequently, these characteristics are also always in a state of change.
DEAF SPECIFIC GENERAL INFORMATION WEBSITES Women United (DWU) DWU as a national organization was born at the first national conference of, by and for Deaf women, held July 1985 in Santa Monica, CA. It has created a network that focuses on advocacy, education and outreach; providing leadership and training in areas of organizational management, personal growth and a clearinghouse of resource information to empower Deaf women. Association of the Deaf (NAD) NAD, established in 1880, is the oldest and largest constituency organization safeguarding the accessibility and civil rights of Deaf and Hard-of-Hearing Americans in education, employment, health care, and telecommunications. A private, non-profit organization, it is a federation of state association affiliates and direct members that provide: grassroots advocacy; captioned media; certification of American Sign Language professionals; certification of sign language interpreters; deafness-related information and publications; legal assistance; policy development and research; public awareness and youth leadership development. Black Deaf Advocates, Inc., (NBDA) The NBDA was formed in response to concerns that Deaf and Hard-of-Hearing African Americans were not adequately represented in leadership and policy decision-making activities affecting their lives. NBDA was established in 1982 to promote the educational, cultural, social and economic advancement of Deaf and Hard-of-Hearing African Americans It is the oldest and largest consumer organization of Deaf and Hard-of-Hearing African Americans in the United States. Membership includes African-American adults who are Deaf or Hard-ofHearing; parents of African American children who are Deaf or Hard-ofHearing; professionals who work with Deaf and Hard-of-Hearing children and adults, and other interested individuals. Asian Deaf Congress (NADC) NADC is a nonprofit organization created to define and address the cultural, political and social issues experienced by Asians who are Deaf or Hard-of-
Hearing. NADC has establish a national clearinghouse of information and research for its members and organizations who represent various geographic regions, languages, religions, cultures and generations. Some of the services it provides include: advocacy and a network of resources on political, social, human rights and other concerns of the Asian Deaf and Hard-of-Hearing community; training opportunities for employment, education and leadership; promotion of cultural and ethnic identities, as well as sharing and celebrating history, heritage and traditions; promotion of collaborative relationships and alliances among Asian Deaf and Hard-of-Hearing individuals, communities, organizations and professionals to provide immigration and acculturation assistance, support and technical and communication assistance.
Provides a home in cyberspace for Deaf Latinas and Latinos! While this website is accessible to genté (people) throughout the world, it is a website that is primarily by, for and about the Deaf Latino/a community in the United States. The site is just getting underway. Since most Deaf Latinos/as in the U.S. do not speak, read or write in Spanish, this website is published primarily in English. A Spanish version may be added in the near future. Links to Alta Vista Spanish translation service have been included throughout the website. Deaf Council (IDC) The Intertribal Deaf Council (IDC) is a non-profit organization of Deaf and Hard-of-Hearing American Indians whose goals are similar to many Native American organizations. IDC promotes the interests of its members by fostering and enhancing their cultural, historical and linguistic tribal traditions. The council strives to provide useful information on human rights and resources for solutions to advance issues related to the social, educational, economic and environment well-being. It is believed to be the only North American non-profit organization for Deaf, DeafBlind, and Hard-of-Hearing American Indian, Alaska Native, and First Nations individuals and their families. Its purpose is to provide a place where American Indians, Alaska Natives and First Nations Indians (Canada) who are Deaf, DeafBlind (or low vision), Hardof-Hearing or late deafened can have access to information about their heritage, traditions and cultural beliefs. Queer Resource Center (DQRC) The Deaf Queer Resource Center (DQRC) is a national non-profit resource and information center based on the web. This is "the place" to find the most comprehensive and accurate information by, for and about the Deaf Lesbian, Gay, Bisexual, Transsexual, Transgender, and Intersex communities. DQRC is entirely volunteer-run and was founded on September 1, 1995. The site offers information, resources, chat room, bulletin board and links to related sites. Rochester Institute of Technology's compilation of related websites Gallaudet University's Library of related resources
For Non-Deaf specific sites with valuable information on domestic and sexual violence issues check out the National Violence Against Women (VAWnet) website page and links area.
The resources listed on this page are not comprehensive and/or all-inclusive. Each link above will open in a new browser window - NRCDV is not responsible for the content and/or viewpoints expressed on web sites external to VAWnet.
June 23 2004 02:23 PM © 2001/2/3 - VAWnet - ALL Rights Reserved Form | & Safety || of Use | Statement |
VAWnet is a project of the Pennsylvania Coalition Against Domestic Violence () and the National 6400 Flank Drive, Resource Center on Domestic Violence ( ) is supported by grant number UIV/CCU312521-08 from Suite 1300 the National Center on Injury Prevention and Control ( ) , Centers for Disease Control and Harrisburg, PA 17112-2778 Prevention (). Voice 1 800 537-2238 TTY 1 800 553-2508 Other products, organizational names or content mentioned on this site may Fax 717 545-9456 be trademarks, registered trademarks and/or copyright of their respective organizations and are hereby acknowledged
Violence Against Vulnerable Adults in the Court System by Tammy Lemmer, Senior Program Manager, Michigan Coalition Against Domestic and Sexual Violence
Many individuals involved in the field of criminal and civil legal justice are familiar with the topics of domestic and sexual violence, thanks in part to increased funding and attention through legislation such as the Violence Against Women Act. Originally passed in 1994, subsequent reauthorization of the act has included additional language addressing the needs of women with disabilities, and providing funding for expanded protection, services, and education. Individuals and systems that continue to become more aware of the dynamics of abuse are better able to respond appropriately to victims and ensure accountability for perpetrators. However, response to violence against people with disabilities and elders is still a particularly under-recognized and under-reported social problem and crime. It is crucial that attorneys and other individuals working with vulnerable adults learn to recognize and respond to suspected abuse and neglect. It is the goal of this article to assist the practicing bar in understanding individual roles and responsibilities and to learn where additional support and referral services are available for clients. While no one can realistically be an expert in all areas of service, it is in everyone’s best interest to understand individual roles and responsibilities, and to learn where additional support and referral services are available for clients.
Types of Abuse Individuals with disabilities experience forms of violence and abuse similar to those without disabilities, such as physical injury, sexual assault, emotional trauma, isolation, and financial abuse. However, persons with disabilities also face unique forms of abuse, such as removal or disabling of assistive equipment, manipulating or withholding medications, or refusal to provide essential personal assistance. The exertion of power and control of one individual over another is a shared characteristic of vulnerable adult abuse and domestic violence. Unique to vulnerable adult abuse is the role of caregiver or personal care assistant in perpetrating the abuse or neglect.
Indicators of Abuse and Neglect When interacting with a client, it may be possible to identify signs of abuse or neglect. For example, is the individual easily frightened or fearful? Exhibiting denial? Agitated or trembling? Hesitant to talk openly? Offering implausible explanations for signs of injury or recent actions? Making contradictory statements? What do you notice about availability of equipment or adaptive devises, the condition of the equipment, the client’s personal hygiene and/or unsafe unclean living conditions, suspected dehydration and/or malnutrition, unattended or untreated medical conditions? All of the above may be indicators that abuse or neglect is present.
Indicators of Abuse Perpetration Individuals present and purporting to be assisting your client might exhibit suspicious behavior as well. Does the caretaker or family member regularly describe the person in their care as “difficult,” “stupid,” or “clumsy”? Are they overly attentive to the person in the presence of others? Do they actively try to convince others that the individual is crazy or incompetent? Do they refuse to allow an interview or examination without being present? These may be signs of a controlling or abusive situation, or that the caregiver has something to hide.
Meeting the Needs of People with Disabilities and Elders In working with elders or people with disabilities, attorneys may be expected to interact with voluntary and/or court appointed decision-makers. This may include individuals with Durable Power of Attorney (for healthcare and/or fiscal management issues), a Guardian (appointed by Probate Court to make various decisions about the care of someone determined unable to make those decisions on their own), or a Conservator (a person or bank appointed by probate court to handle some or all of an individual’s assets and financial affairs). While the role of these individuals is to support the vulnerable adult, these people are in perhaps the easiest position to take advantage of the situation. It may be tempting to rely on the caregiver or appointed representative for information, but every attempt should be made to speak directly with the individual, and to gather information from multiple sources. Individuals with disabilities are not only at greater risk of abuse, they have greater barriers to seeking or accessing resources and support, such as not being believed or taken seriously. These barriers that deny or limit access to quality advocacy and services for victims of abuse and neglect also include lack of formal screening for domestic violence, sexual assault or other forms of abuse for people with disabilities, and failure of other professionals to identify and adequately address the needs of vulnerable adults. To address these and other gaps in meeting the needs of vulnerable adults, the Michigan Elder Abuse Task Force was established by Executive Order 2005-11 on May 25, 2005, by Governor Jennifer Granholm. The Task Force released its report on August 23, 2006, which included a number of recommendations for increased support, accountability, and policy change. A link to the full report can be found below. According to the report, “during calendar year 2005, Michigan’s Adult Protective Services Program through the Department of Human Services received 14,641 referrals of suspected abuse, neglect, and/or exploitation of elderly and disabled persons. Based on national statistics, the incidence of reporting is one in five for abuse, neglect, and/or exploitation. For Michigan, this translates to 73,205 residents suspected of being abused, neglected, and/or exploited. This does not take into account the number of calls received by state and local law enforcement agencies regarding elderly victims of crime.” Governmental and community-based resources are available to provide support and assistance to vulnerable adults and professionals that work on their behalf. The primary contact when abuse and/or neglect are suspected is Adult Protective Services (APS) through the Department of Human Services. Goals of that agency are designed to provide immediate (within 24 hours) investigation and assessment, to assure adults in need of protection are living in a safe and stable environment, and to provide assistance in the least intrusive or restrictive manner possible. Other statewide partners include Michigan Protection and Advocacy Services (MPAS), Office of Services to the Aging (OSA), Michigan Commission on Disability Concerns, and the Michigan Disability Rights Coalition. Regional resources include local Area Agency on Aging, Centers for Independent Living, and Regional Interagency Coordinating Councils. Other disability specific resources include Community Mental Health offices, Michigan Developmental Disabilities Council, ARC Michigan (formerly Association for Retarded Citizens), and United Cerebral Palsy (UCP). Finally, remember that an important concept in working with people with disabilities and elders is autonomy and self-determination, or person-directed services. Knowledge emerging from both violence research and investigations of outcomes associated with person-directed services documents that individuals are generally best able to maintain their safety when they control their services and supports.1 In other words, it is not up to the service provider or professional to make all the decisions for the individual. This is summed up well in the mantra from the disability community: “Nothing about us without us.” Similarly, the concept of “people-first language” (i.e. referring to an individual as a person with a disability rather than a disabled person) reflects that regardless of their physical or developmental status, these individuals are people and deserve the right to make decisions that affect their lives.
If you suspect a client is a victim of domestic or sexual violence or for more information on various forms of mental or physical disabilities, refer to the resources identified below, or contact Tammy Lemmer at the Michigan Coalition Against Domestic and Sexual Violence at
[email protected].
References 1
Violence and Abuse Against People With Disabilities: Experiences, Barriers and Prevention Strategies, Laurie E. Powers, Ph.D., Mary Oschwald, Ph.D. Center on Self-Determination, Oregon Institute on Disability and Development, Oregon Health & Science University, 2004
Resources Disability Resources Monthly (online resource) ://www.disabilityresources.org/ABUSE.html
Available bibliographies include:
Legal and Policy Resources for Advocates and Criminal Justice Professionals Sexual Assault & Domestic Violence and Persons with Disabilities Video Resources on Domestic Violence in Later Life and Elder Abuse Print Resources on Domestic Violence in Later Life and Elder Abuse
National Coalition Against Domestic Violence Fact Sheet: Domestic Violence and Disabilities ://www.ncadv.org/files/disabilities.pdf The National Council for Support of Disability Issues Mission Statement: The National Council for Support of Disability Issues shall help advance public attitudes, awareness, respect, and consideration and advance the success of people with all types of disabilities. ://www.ncsd.org/ Violence and Abuse Against People with Disabilities: Experiences, Barriers, and Prevention Strategies, Powers and Oschwald (2004) ://www.directcareclearinghouse.org/download/AbuseandViolenceBrief%203-7-04.pdf
Author Contact Information Tammy Lemmer, Senior Program Manager Michigan Coalition Against Domestic and Sexual Violence 3893 Okemos Rd, Suite B2 Okemos, MI 48864 (517) 347-7000, ext. 27
[email protected] .mcadsv.org
Previous issues of Disabilities Project Newsletter:
Traumatic Brain Injury Push-Out of Children with Disabilities from School the Legal Needs of Deaf Individuals 'But You Look So Good!' and 7 Other Things NOT to Say to a Person With a Non-Visible Disability Protection and Advocacy Service, Inc. Provides Advocacy to People with Disabilities Proper Accommodations for Deaf Law Students a Person with a Visual Disability in the Legal Process Persons with Non-Obvious Limitations in Mobility to Community Resources the Cognitively Disabled Client in a Criminal Case and the Courts Access to Michigan Courts Advocates as an Accommodation for Individuals with Disabilities -Cost Ways Courthouses Can Be More Accessible to Persons With Disabilities and Hard of Hearing
Websites for Resources on Disbility Issues:
://www.dhhs.state.nc.us/disabilities/index. ://www.ncdhhs.gov/mhddsas/developmentaldisabilities/index. ://www.dhhs.state.nc.us/dsdhh/ ://www.dhhs.state.nc.us/dsb/index. ://www.nc-ddc.org/ .disabilityrightsnc. . ://disabledfeminists.com/2010/07/13/disability-and-domestic-violence-apologism/ ://www.liebertonline.com/doi/abs/10.1089% ://heinonline.org/HOL/LandingPage?collection=journals&handle=hein.journals/umkc69&div=16&id=& = ://www.bcm.tmc.edu/crowd/
://dawn.thot.net/index.
://www.austin-safeplace.org/
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