DFSA Research
 




Women with Disabilities

Providing Services to Clients with Disabilities who have Experienced Abuse: What to Expect and What You Should Know

 

What is Disability?

The World Health Organization refers to disability as a “complex phenomenon,”[1] that can be experienced as “impairments, activity limitations, and participation restrictions.”[2] Disabilities can be psychological, physical, sensory, or cognitive in nature. This can involve any mobility, visual, or hearing impairment, as well as facial disfigurement, communication difficulties, learning disorders, psychiatric issues, or developmental disabilities. Some disabilities may be hidden, for example chronic illnesses like diabetes, Crohn’s Disease, epilepsy, or environmental illnesses (e.g., Multiple Chemical Sensitivities).

            Disability activists refer to disability as a contextual issue. They argue that the ‘problems’ women living with disabilities face are not a result of their impairment, but rather the limitations and barriers imposed by others, which limit their full participation in society.

What is Sexual Assault/Domestic Violence for Women Living with Disabilities?

Violence against women living with disabilities can take a variety of forms. Abuse is classified as deliberate maltreatment and harm to another person.[3] However, for women living with disabilities abuse may present in other forms, for example, as neglect. Women living with disabilities who live in institutions, or women with multiple disabilities, may be more vulnerable to abuse, less likely to seek help/leave, and experience abuse for longer periods of time from intimate partners and support workers.[4]

In the World Health Organization’s review on abuse against adults with disabilities, it was found that “overall they are 1.5 times more likely to be a victim of violence than those without a disability. Women with mental health conditions specifically are at nearly four times the risk of experiencing violence.”[5]  The DisAbled Women’s Network of Ontario reports that in response to a survey done with women living with disabilities, 53% of the women who had been disabled from birth or early childhood had been abused.[6] Abuse can include:

Physical abuse:

Anything that may cause harm or injury to the body is considered physical abuse.[7] This may include violent assault, rough or inappropriate handling, inappropriate medical care, restraint, overmedication, and confinement. As well, caregivers who fail to report serious symptoms, perform care in cruel ways (e.g., washing her in cold water), and who purposely make the woman miss medical appointments are also considered physically abusive.

Any act that forces another person into any sexual activity.[8] Unwanted sexual touching, forced touching of another person’s intimate body parts, forced abortion or sterilization, as well as denial of a woman living with disabilities’ sexuality or denial of sexual information/education (e.g., birth control). A situation where the caregiver is rough with intimate body parts is also considered sexual assault.

Verbal abuse:

The use of words to hurt another person, often with the aim of minimizing a person’s self-worth/self-esteem.[9] This may include speaking down to a woman, swearing, or making the woman believe she is worthless or stupid, yelling at her, and calling her names.

Emotional/Psychological abuse:

This form of abuse often goes hand in hand with verbal abuse in that the actions may negatively affect a woman’s self-worth/self-esteem.[10] However, it can also include “intimidation, social isolation, emotional deprivation, [and] denial of the right to make personal decisions.”[11] Other examples include ridiculing a woman by saying no one else will love her and calling her names. As well, when a caregiver refuses to speak to a woman or ignores her requests, or uses negative reinforcement, they are being emotionally/psychologically abusive.

Neglect/Isolation:

Depriving a woman living with disabilities’ basic needs and human rights.[12] This may include not providing the woman with enough to eat, or leaving her alone for extended periods of time. Isolation may take the form of disconnecting communication devices, breaking or hiding mobility equipment, or not equipping a transportation vehicle so that it can be driven by someone with a disability. Caregivers may limit access to family/friends/neighbours, limit employment opportunities, and/or discourage contact with social workers.

Using children:

Threatening to have a woman’s children taken away is another form of abuse. A partner may threaten to get custody if she tries to leave, or threaten to issue false reports about her parenting to a social worker, leading to the potential removal of her children.

Economic:

Financial exploitation includes denying access to and control over a woman’s own finances, misuse of her financial resources, or forcing her to sign cheques. A caregiver may use the woman’s personal property and money for themselves, steal money, or make financial decisions without her consent.

Who are the Abusers of Women Living with Disabilities?

In both disabled and non-disabled communities of women, abuse most often occurs at the hands of someone known to the individual.[13] Perpetrators may be intimate partners, family members, acquaintances, and strangers. For women with disabilities, however, caregivers represent an additional perpetrator group. Caregivers can include support workers/attendants, interpreters, drivers, doctors/nurses, therapists/psychiatrists/counsellors, hospital staff, or social workers.[14]

In a recent population-based study of 860 women in the United States, the investigators compared those women with a disability to those without. It was found that amongst those who experienced some type of abuse, husbands and live-in partners were the most common perpetrators of abuse. Furthermore, women living with physical disabilities who use a personal support worker were more vulnerable to assault because of the reliance on another person for care, support, and security.[15] 

Barriers to Help for Women living with Disabilities

For an abused woman, and particularly a woman living with disabilities, leaving an abusive situation can be very difficult. The following are several commonly cited barriers that women with disabilities may face when it comes to seeking help.

A loss of self-esteem as a result of abuse

Abuse, in any form, can be demeaning for a victim. A woman may come to believe, after prolonged abuse, that she is directly responsible or deserves to be abused and thus will lack the self-esteem to seek help. As well, women may maintain hope that their situation will change.

Dependence on abuser

The woman may be dependent on her abuser for “affection, communication and financial, physical and medical support.”[16] This loss may put her at greater risk for poverty, housing conflicts, or being institutionalized.[17] Thus, a woman may stay in an abusive situation, believing it is the best choice, where poverty or homelessness is the alternative. Religious beliefs may deem it unacceptable for a woman to leave her husband, which adds another potential barrier to leaving.  This may be compounded if the woman shares children with her abuser; she may fear losing her children, or may have difficulties leaving with them.

Lack of access to services/information

A woman may not have enough information about services available to her, or may not know where she can seek help. In the case where the abuser is the caregiver, they may withhold this information from the woman. Furthermore, even if she does have the information, it may not be accessible as a result of her disability. For example, if a shelter is not equipped with Teletypewriters (TTY), then a hearing impaired woman will not be able to call them in a time of need. As well, physically leaving an abusive situation may be more difficult if accessible transportation/facilities are not available. If agencies are not equipped to help, a woman may be referred back and forth between various violence-related services and disability services—falling just outside the realm of support each can offer. There may also be a lack of access to accessible transportation, particularly in more rural areas. This may also pose a barrier to leaving an abusive situation, or even seeking help.

Lack of training and knowledge for service providers working with women living with disabilities

Unless specialized training has been provided, service providers (shelter workers, counsellors, social workers, etc.) may not have a full understanding of the issues, experiences, needs, and rights of women living with disabilities. As well, they may not know the correct etiquette for aiding women who require assistance. The paucity of research and services for women with disabilities experiencing sexual assault/domestic violence leads to the perpetuation of gaps in (appropriate) service provision.  Inadequate training can mean that services are not provided in a sensitive manner.

Fear

A victim of abuse will likely fear increased violence, particularly if the abuser finds her once she has already left. A woman’s greatest risk for injury and/or being killed by their partner is after the relationship has ended.[18] Other fears can include; fear of being alone, being shamed by family, friends, and others within the community, and fear of having children taken away, or in the case of a caregiver, fear of withdrawal of services. Women living with disabilities may also fear being institutionalized if the abuser is a primary caregiver/financial supporter, or that people will not believe her or minimize the abuse, which is a commonly cited issue for women living with disabilities.[19]

Common Disabilities and Things to Consider as a Service Provider

As a service provider working with women with disabilities who have experienced sexual assault and domestic violence, it is important to provide supportive and nonjudgmental care and to assist the woman to maximize her independence. Assisting her to access appropriate social services and supports will assist her to maintain her autonomy. What follows is not a comprehensive list of all disabilities, but instead a short-list of common disabilities. Each is followed by recommendations for things to consider as a service provider already working with sexual assault and domestic violence victims.

 

Vision Impairments:

Vision impairments may range from low vision to blindness. Although Braille is commonly thought of as the primary form of reading comprehension for those who are blind, only a small number of blind women read Braille.[20] More contemporary computer software and other technologies have taken the place of Braille, serving as more convenient reading equipment.

Things to consider:

Informative/educational materials available in Braille/large print formats/electronic formats (so that reading software like Kurzweil ‘Text to Speech’ literacy software can be applied.)

Remember that people who have not had vision since birth may have difficulties understanding verbal descriptions of certain objects/concepts. For example, during a physical examination, you may be inclined to add descriptors of instruments so that the woman with visual impairments is aware of what is happening. However, making comparisons, such as, “it looks like xyz,” may not be helpful. If the woman has been blind since birth, she will not know what xyz looks like.

When initiating a conversation be sure to lightly touch the woman’s arm or say her name to attract her attention.[21]

Use the same tone of voice you would use with any other client when speaking to someone who is visually impaired. Keep in mind that women with visual impairments may not respond to hand and facial gestures.[22]

Never pet a guide dog; you must remember that they are on duty and should not be distracted. Ask the owner for permission before interacting with the dog.[23]

 

Hearing Impairments:

Much like visual impairments, hearing impairments can range in severity from partial hearing loss/hard of hearing to being deaf. That means that some women may be able to hear at a functional level using devices like hearing aids, while others may only hear things at certain frequencies or may not be able to hear anything at all. Some women with hearing impairments read lips instead, while others may wear a hearing aid. In order for women with hearing impairments to communicate via telephone, a Teletypewriter (TTY) is required. A TTY allows both parties to type messages to each other back and forth, in place of speaking/listening.

Most often, those with hearing impairments will use a combination of all these methods—lip-reading, ASL, and amplification devices.[24]

Because of the sensitivity of hearing aids, certain everyday objects that make relatively faint noises like fans or lights can be a bother to people who use hearing aids, limiting their ability to hear properly.[25]

Things to consider:

You should always face the person with a hearing impairment, rather than the interpreter. Also, be sure to speak directly to the person and at a regulated pace

In the case that an interpreter is being used, refrain from using jargon and speak at a regulated pace.

Speech Impairments/limited verbal communication

Speech impairments can include “disturbances in articulation, voice production, rhythm (stuttering), neurology (e.g. cerebral palsy, hearing impairments, intellectual disability and associated conditions) or organic causes (such as cleft palate).”[26]

Computer-based speech output systems are the method commonly used by persons who cannot speak, such as Augmentative and Alternative Communication (AAC).

 

Things to Consider:

Take your time, be patient, and concentrate on what the person is saying

Wherever appropriate, try to ask questions in a way that requires a short response

Do not speak on behalf of the woman, attempt to finish her sentences, or ‘translate’ what she is saying for others, unless she has given you permission to do so

If you are still having difficulties understanding what she is saying, provide her with pen and paper to write it out.

Learning Disabilities

A learning disability is understood as “a neurological dysfunction which interferes with the brain’s capacity to process information in a conventional manner.”[27] Learning disabilities can range in severity.

Learning disabilities are not indicative of a person’s overall intelligence.[28] However, as a result of a woman’s learning disability, she may find it more difficult to express herself and may take longer to process information.

 

Things to Consider:

Be aware of environmental factors in the immediate surrounding which may be distracting

Be sure to ask the woman about her preference for communication. Her preference may be written, verbal, visual, or a combination of several forms of communication.

Be patient, repeat things if necessary.

Make the woman aware you are open to feedback at any point to maintain an open line of communication

 

Mobility Impairments

Mobility impairments “range from lower body impairments, which may require use of canes, walkers, or wheelchairs, to upper body impairments, which may result in limited or no use of the hands.”[29]

Women with mobility impairments may require special accommodation to use facilities

Things to consider:

Offer physical assistance, where it seems appropriate and welcomed

A woman’s wheelchair or walker is an extension of her own body. Thus, leaning or putting your feet on these aids is inappropriate.

Regardless of what aids the woman uses, speak to her the way you would to any other and whenever possible, attempt to speak to herat eye-level (i.e., sit on a chair across from someone in a wheelchair)

Health Impairments

A health condition can have significant affects on a person’s ability to engage in daily activities. For example, certain medications may affect energy levels.

Health impairments can sometimes be invisible, meaning that they may not be outwardly apparent. For example, Chronic Fatigue Syndrome or Environmental Disabilities such as Multiple Chemical Sensitivities.[30]

Health impairments, whether visible or invisible, may occur episodically. This means that a period of health may be interrupted by illness.[31] These episodes are often unpredictable in nature and can range in intensity and length of time. Examples include HIV, multiple sclerosis, lupus, arthritis, cancer, and diabetes.[32]

Things to Consider:

Be cognizant of the fact that a person’s medication may alter their physical, emotional, and cognitive state.

Do not overlook health impairments as disabilities as you are likely unaware of the daily barriers that woman face as a result of them

Psychiatric/Psychological Disabilities

There is a range of conditions and diagnoses that fall under this heading. These include Major Depressive Disorders, Schizophrenia, and Bipolar Disorder. These conditions are often treated with medications and/or with therapy.”[33]

Ensure consistency in interactions

Be clear with instructions

Multiple Disabilities

Some women may present with more than one of the above disabilities. For example, a woman with mobility issues may also have a psychiatric disability.

Things to consider:

It is important, as a service provider, to understand that women living with more than one disability may have an increased vulnerability to victimization.[34]

Recommendations for service provision

Research on women living with disabilities and their experiences with sexual assault and domestic violence has only recently begun to gain momentum.[35] We must work together to continue to build knowledge, create a space to change the nature of conversations regarding disability and abuse, and promote new health messages.

Based on availability, service providers should be aware of local services for abused woman with disabilities. Particularly services that offer subsidized/sliding-scale counselling.

Service providers working with sexual assault and domestic violence victims should be knowledgeable on the needs of women living with disabilities and the different ways they may communicate

One reason why women living with disabilities face difficulties leaving an abusive situation is that they feel there is nothing that exists to help them leave their abusive situation.[36] 

In general, social myths and attitudes about women living with disabilities need to change in order for the related inequalities to change. Service providers can help to reinforce positive self-esteem amongst their clients. Keep in mind that these women are like any other, with their own unique skills and abilities.

If a facility is not fully accessible, make your building manager aware of this

Seek training in how to promote helpful information/procedures for working with women living with disabilities.

Avoid colloquial expressions to describe disability, such as “physically challenged” or “differently-abled,” as these are often considered condescending.

Always speak directly to the woman and “focus on her abilities rather than her disability.”[37]

Do not make assumptions about someone’s preferred method of communication. For example, not everyone with a hearing impairment can/prefers to read lips.

Work within an anti-oppression framework which acknowledges the systemic barriers of women living with disabilities. This is important as a way to move away from victim-blaming and bring greater attention to the social determinants that make these women vulnerable to abuse.

Be patient, non-judgmental, and compassionate

Resources

Ontario Network of Sexual Assault/Domestic Violence Treatment Centres: Standards of Care

The Americans with Disabilities Act: Checklist for Readily Achievable Barrier Removal

DisAbled Women's Network of Ontario: Access Checklist

Last update: 05 September 2014