Lund, E. (2011). Community-based services and interventions for adults with disabilities who have experienced interpersonal violence: A review of the literature. Trauma, Violence & Abuse, 12 (4), 171-182.
Summary provided by Tom Underwood
The purpose of this literature review was to assess community-based interpersonal violence services and intervention programs for adults with diverse disabilities. The reviewer searched for articles from May 1995 to May 2010 via several recognized databases. The primary condition for review consideration was whether the article provided detailed information about a victim services program specifically for persons with disabilities. Further, articles could only be published in peer-reviewed journals, had to include original data, and was limited only adult participants. A total of sixteen articles were included in the review. While the established criteria limited the breadth of the review, limits regarding empirically evaluated interventions and populations are necessary in order for clear understanding of application and effectiveness.
The reviewer found six of the thirteen articles dealt with accessibility of community-based interpersonal violence services to persons with disabilities. The finding was that most victim service programs reported having served at least a limited number of women with disabilities, most commonly persons with a mental illness disability or a developmental disability. While these studies suggested relatively high usage of services by persons with disabilities, true usage is unknown since victim service programs do not tend to screen for disability at intake. The numbers may be higher due to decisions by victims to not self-disclose regarding a disability and service provider lack of awareness about disabilities. On the other hand, lack of accessibility may result in significant under usage by victims. Upon inspection, programs that identified themselves as physically accessible were not necessarily so. Further, programs often were not programmatically accessible as evidenced by inadequate signage, alternate format materials, and so forth.
A majority of the reviewed articles included information about prevention or intervention programs. Various types of programs were reviewed: behaviorally-based abuse prevention, cognitively-based abuse prevention, and psychoeducationally-based abuse prevention. All three approaches realized limited support. A common challenge with all three approaches was the limited transferability or generalizability to naturalistic settings. Further, these studies had very small sample sizes and typically included only women with developmental disabilities thereby limiting generalizability.
One finding of the cognitive-based programs is that “participants in the self-directed decision making treatment group scored significantly higher … on measures of self-directed decision-making practices and internal locus of control” (p. 177). This finding tends to hold true in the areas of education and intervention. That is, control of one’s own learning, recovery, and well-being tends to realize positive results. While oftentimes well-meaning service providers may not consider persons with disabilities as having the capacity for control, the values of self-determination and control that underlies victim services are applicable to persons of all abilities.
A couple of additional observations from this review. First, there is a lack of training regarding disability issues in the field of victim services as well as lack of training regarding interpersonal violence issues in the field of disability services. This lack of training can be attributed to a lack of organizational resources, that is time and money, as well as lack of awareness regarding the scope of the problem. As mentioned previously, victim service programs generally do not screen for disabilities and may well not have persons with disabilities using services due to lack of accessibility. Similarly, disability service practitioners may not have an awareness of interpersonal violence issues of the individuals served. Regardless of the causes, both fields have a professional obligation to enhance knowledge and develop collaborative relationships.
Second, it is extremely difficult to adequately assess program accessibility and services with the general classification of disabilities when there is a spectrum of abilities across the population. The author stated that the purpose of the review was to review programs and services for individuals “with diverse disabilities” (p. 172). For the purpose of this review it may have been better to have narrowed the type of disability since the review really did not address “diverse disabilities” but instead focused mostly on developmental disabilities. This is not to suggest that we should focus only on development disabilities nor should we create typologies. Quite the contrary; we need to recognize the uniqueness of each victim, including the abilities of each individual.
Thomas Underwood is the Executive Director of the Joint Center on Violence and Victim Studies (JCVVS) as well as the Assistant Dean of the Office of Academic Outreach at Washburn University where he administers select high level professional development courses associated with academic units. In addition to his development and instruction of a variety of professional development courses, he has also taught academic courses in victimology for Washburn University and California State University, Fresno. He is a founding member of the American Society on Victimology, an affiliate of the World Society of Victimology, and serves on its Executive Board. Dr. Underwood has authored and co-authored, edited, and reviewed numerous articles and book chapters related to victims of crime.
Response by Marcie Davis
Author Emily Lund conducted a comprehensive search of peer-reviewed literature from 1995 to 2010 regarding violence-related service, prevention and intervention programs for individuals with disabilities. As an advocate with over twenty-five years in the field of violence against individuals with disabilities, it is not surprising to me that Ms. Lund’s search only revealed 16 qualifying articles. In my experiences, the field of violence against individuals with disabilities during this timeframe has been extremely limited. Few research projects have focused on individuals with disabilities and many domestic violence, sexual assault, and law enforcement agencies do not collect data specific to disability and how disability is or is not impacted by violent crime. This reality was demonstrated in Lund’s research by McFarlane and colleagues (2001) where it was “found that failing to ask questions specifically about disability-related violence artificially suppressed the prevalence of violence among women with disabilities.”
Lund’s study outlined three main aims: (1) Provider and Community Services Articles; (2) Intervention and Prevention Programs; and (3) Recommendations and future implications for future policy, research, and practice based on the Provider and Community Services and Intervention and Prevention Programs that was studied.
In Aim 1: Provider and Community Services Articles, the information gathered noted that both studies reviewed indicated a high level of physical accessibility. However, Frantz et al. (2006) indicated that programs reported a higher level of physical accessibility as opposed to programmatic accessibility. This is consistent with my experience in the field. Many direct service providers including the criminal justice field, believe their programs are accessible if they provide physical accessibility such as designated parking, ramps into a facility, and one accessible bathroom stall. While these aspects of physical accommodation are important, they do not address programmatic accessibility. Survivors that we serve have indicated that domestic violence shelters had difficulty accommodating those who are blind or deaf. Individuals with vision loss often did not receive a guided tour providing them with detailed facility layout. Individuals who are deaf often were not provided interpreters. Both of the situations limited the individual’s ability to fully access the programmatic services available. Furthermore, survivors with disabilities have reported that direct service providers are often embarrassed and uncomfortable responding to their disability-related needs and equally uncomfortable acknowledging that they are sexual beings who have experienced violence. Some direct service providers have difficulty understanding the level of impact disability has on victimization. Safety planning and exiting an abusive situation becomes more complex when it is coupled with one or more disabilities. Women with disabilities often do not have the same choices available to them that women without disabilities may have. For example, they may not be able to drive, pack their belongings independently, support their children, have the physical and/or mental capabilities to take charge of their life and exit a home or relationship.
As Lund’s article suggests, many of the barriers individuals with disabilities encounter when attempting to access a community-based program can be linked to lack of funding and lack of cross-training. I have witnessed both of these factors throughout my career. We have been working diligently to bring both disability and non-disability advocates and service providers to the table to collaboratively build sustainable partnerships and coalitions. Through these working relationships, we can cross-train each other and build a lasting bridge between disability and victim service providers. Centers for Independent Living, Vocational Rehabilitation, and other direct disability service providers offer excellent opportunities to reach individuals with disabilities who may have no other contact or outlet to reveal their victimization.
I wholeheartedly agree with Lund’s findings that “increased research attention should be paid to the development and rigorous testing of IPV [Interpersonal Violence] intervention programs that address the specific needs of individuals with diverse disabilities and those who are Deaf and Hard of Hearing.” As stated above, any type of disability will impact victimization. It can add a level of stress and increase the individual’s anxiety and concern for personal care, safety, and future consequences. Disability cannot be ignored if that individual is to receive effective victim services throughout their participation in the criminal justice system. More large scale research studies must be conducted in order to increase awareness and to produce effective protective factors that respond to the unique needs of individuals with disabilities.
I agree with Lund’s assessment that there is a strong disconnect between service providers’ perceptions regarding physical and programmatic accessibility. For the average person with a disability, it is not always realistic to expect that after reporting a crime one would become an active and equal participant in the criminal justice system. It can be overwhelming and difficult to navigate an inaccessible system, arrange transportation to attend multiple hearings and court dates in facilities that are challenging to access, all while putting their own safety and the safety of their children and families at risk. Not to mention, while still trying to maintain their health coverage, purchase all the necessary medical supplies and equipment to enable them to function at an acceptable level, and ensure a living for themselves and any dependent family members. I applaud Lund’s efforts to research the literature on this topic. And as her work has successfully demonstrated, we have only begun to scratch the surface of the vast and unique needs and issues impacting crime victims with disabilities.
Frantz, B. L., Carey, A. C., & Bryen, D. N. (2006). Accessibility of Pennsylvania’s victim’s assistance programs. Journal of Disability Policy Studies, 16, 209-219.
McFarlane, J., Hughes, R. B., Nosek, M. A., Groff, J. Y., Swedlend, N., & Dolan Mullen, P. (2001). Abuse assessment screen-disability (AAS-D): Measuring frequency, type, and perpetrator of abuse toward women with physical disabilities. Journal of Women’s Health and Gender Based Medicine, 10, 861-866.
Marcie Davis is the Chief Executive Officer of Davis Innovations, a research and organizational development consulting firm. She is an internationally recognized victim assistance and disability advocate and trainer who leads a diverse staff in providing program development, management, training, technical writing, grant writing, research and evaluation services to local, state, federal, and tribal governments and NGOs. She has a Bachelor of Science in Paralegal Studies and a Master of Library Science, both from the University of Southern Mississippi . Her many publications include: The SANE Response to Persons with Paralysis, Working Like Dogs: The Service Dog Guidebook, and A Law Enforcement Guide for Working with Children with Autism, Intellectual and Communication Disabilities. Ms. Davis is accompanied by her assistance dog, Whistle. She is also the host of Working Like Dogs on Pet Life Radio.