- The concept of “disabilities” covers a multitude of conditions, with different vulnerabilities and needs. When identifying and addressing risks for violence among disabled women and girls, it is important to focus on particular types of disabilities (i.e. those involving sensory impairment, physical impairment, psychiatric impairment, cognitive impairment, etc.) as well as particular types of violence, and develop research and programming accordingly.
- In general, however (and regardless of the disability), health care providers should at minimum understand that women and girls with disabilities may be at the same or higher risk for violence than those without disabilities due to issues of power and control. In order to assist women and girls with disabilities, health programs should develop specific policies for working with disabled and health care providers should receive specific training. Health facilities should also consider the following strategies
- Conduct community outreach: Women and girls with disabilities may face challenges accessing treatment because they may be isolated in their homes, or in institutions, and in some instances may have limited knowledge about their bodies and sexual and reproductive health and therefore not understand the importance of receiving care. The health system needs to devise strategies to reach out to women and girls with different types of disabilities, and ensure they have access to services.
- Improve facility infrastructure to meet the needs of women and girls with disabilities: This may include providing wheelchairs and wheelchair access, interpreters for the deaf, special examination equipment that prioritizes comfort for those with physical impairments, etc. Health facilities can engage local organizations working specifically with disabled people to determine what other accommodations should be made.
- Recognize and address the specific vulnerabilities to violence that women with disabilities may face.
- Develop screening protocols that recognize some of the particular tactics associated with abuse of disabled women and girls, including 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 (Hoog, 2003).
- Ensure that screening for violence against women and girls is done in an initial private interview, if possible without the caretakers’ presence. Some women and girls with disabilities have caretakers who may be the perpetrators of violence, whether they are family members, staff in institutions, or paid caretakers. Women and girls with disabilities often depend on their caretakers for survival and daily living, which makes it very difficult for them to leave abusive situations (Hoog, 2003).
Screening for Domestic Violence among Women with Disabilities
Key points to remember:
- Develop screening questions that 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 person 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.
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?
- Do you have any health issues that can become dangerous if neglected, such as diabetes, epilepsy, skin sores, cancer or heart disease?
- 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?
Excerpted from Hoog, C., 2003. "Model Protocol on Screening Practices for Domestic Violence Victims with
Disabilities", pg. 7, with information from Curry, M.A et al., 2002. Development of An Abuse Screening Tool for Women with Disabilities.
Example: Sada Action Strategy – New South Wales. The Sexual Assault in Disability and Aged Care Residential Settings (SADA) action strategy, auspiced by People With Disability Australia Incorporated, aims to identify best practice in preventing and responding to sexual assault. It was initiated in 2005 by the Northern Sydney Sexual Assault Service in response to the number of people with disability and older people approaching their service as victims of sexual assault (People with Disability, 2007). In 2006, the project received 2-year funding from the Office for Women to continue its work. The SADA action strategy has involved a number of consultations with stakeholders including across disability, aged care, police and sexual assault sectors in order to identify strategies for action to enable a better response to sexual assault of people living in disability and aged care residential settings. Findings from these consultations have emphasized the importance of recognizing both the sexuality of people with disability as well as their vulnerability to sexual assault (People with Disability, 2007). The project has a website where they are collating existing tools and resources for disability and aged care services to guide prevention and responses to sexual assault. The next phase of the project is to pilot a training package for staff in the disability and aged care sectors on recognising and responding appropriately to sexual assault.
For more information visit the website.
Source: excerpted from Murray, S. & Powell, A., 2008. “Sexual assault and adults with a disability: Enabling recognition, disclosure and a just response” Australian Centre for the Study of Sexual Assault, p.11.
Example: Family Planning Australia. Family Planning in most states and territories offer education and professional training as well as access to resources and information regarding sexuality and relationships for people with disabilities, their parents/carers and professionals working in the disability field. This includes formally accredited training for professionals in the disability sector, as well as consultation and seminars on developing sexuality education programs for people with a disability. Most states also have a disability resource library with materials that can be loaned or purchased, including sexuality and relationshipeducation services for people with disabilities, their parents/ carers and professionals working in the disability field. Family Planning services also offer direct, specialist individual sexuality education for people with a disability. For example, Family Planning Victoria (FPV) run a “Sexuality Education and Intervention Service” which provides education and intervention services to people whose behaviour is placing them at significant risk of sexually offending or being sexually exploited due to lack of knowledge. FPV has developed a “Sexual Assault and Intellectual Disability Resource Kit” for working with victim/survivors of sexual assault who have an intellectual disability. Family Planning New South Wales, with funding from the New South Wales Department of Ageing, Disability and Home Care, provide education and training for professionals in the disability sector to better identify and respond to inappropriate and abusive sexual behaviours.
For more information, see the website.
Source: excerpted from Murray, S. & Powell, A., 2008. “Sexual Assault and Adults with a Disability: Enabling Recognition, Disclosure and a Just Response” Australian Centre for the Study of Sexual Assault, pgs.11 & 13.
Illustrative Resources:
Model Protocol on Screening Practices for Domestic Violence Victims with Disabilities (Hoog, C., 2003). Available in English.
The Women with Disabilities Australia website has a sexual and reproductive rights section, including a number of resources that address violence. Available in English.
Violence against Women with Disabilities (USA) – This website provides numerous resources on addressing violence against women with disabilities. Available in English.
Center for Research on Women with Disabilities at Baylor College of Medicine includes an overview of domestic violence among women with disabilities, as well as educational and other resource materials, including: Gynecological Considerations in Treating Women with Physical Disabilities (ppt) and Improving the Health and Wellness of Women with Physical Disabilities--Clinical Perspectives (ppt)
Sexual and Reproductive Health of Persons with Disabilities: Emerging UNFPA Issues (UNFPA, 2007). Available in English.