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3

Risk Factors for People with Disabilities

People with disabilities may be particularly vulnerable to crimes involving interpersonal violence, such as physical or sexual assault, because as a population—regardless of age or gender—they are often the least able to recognize danger, the least able to protect themselves, and the least able to obtain assistance within the criminal justice system. By the same token, they may be less vulnerable than the rest of the population to other crimes, for example, auto theft, since few of them own vehicles.

This chapter presents the multifactorial model of the risk of violence directed at people with disabilities posited by Dick Sobsey and Peter Calder in their workshop paper. The authors discussed the risk of victimization for persons with disabilities in a historical context of victimization studies generally. Their model is grounded in the fragile empirical research and case study material partially summarized in Chapter 2 , but because of the lack of empirically tested risk factors to explain the increased incidence of violence against people with disabilities, the elements of the conceptual model should be considered as theoretical and untested. Still, the model integrates a wide range of concepts, models, and theories into a rational organizational structure, with five goals:

    1. to summarize the specific risk factors that affect people with disabilities;

    2. to provide a basis for discussing the development of a more refined model or a better alternative model;



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Page 22 3 Risk Factors for People with Disabilities People with disabilities may be particularly vulnerable to crimes involving interpersonal violence, such as physical or sexual assault, because as a population—regardless of age or gender—they are often the least able to recognize danger, the least able to protect themselves, and the least able to obtain assistance within the criminal justice system. By the same token, they may be less vulnerable than the rest of the population to other crimes, for example, auto theft, since few of them own vehicles. This chapter presents the multifactorial model of the risk of violence directed at people with disabilities posited by Dick Sobsey and Peter Calder in their workshop paper. The authors discussed the risk of victimization for persons with disabilities in a historical context of victimization studies generally. Their model is grounded in the fragile empirical research and case study material partially summarized in Chapter 2 , but because of the lack of empirically tested risk factors to explain the increased incidence of violence against people with disabilities, the elements of the conceptual model should be considered as theoretical and untested. Still, the model integrates a wide range of concepts, models, and theories into a rational organizational structure, with five goals: 1. to summarize the specific risk factors that affect people with disabilities; 2. to provide a basis for discussing the development of a more refined model or a better alternative model;

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Page 23 3. to call for the generation of testable hypotheses based on various components of the model; 4. to provide a tentative guide for risk reduction strategies; and 5. to consider the specific risk factors and mechanisms that affect people with disabilities in order to further understanding of violence and violence prevention in general. Significant studies of crime victims began in the middle of the 20th century. Like much of the work that followed, early studies in victimology emphasized the importance of considering the relationship between the perpetrator and the victim. Von Hentig (1948) is credited with first identifying the relationship between disability and victimization when he suggested that four categories of people are particularly vulnerable to victimization: the young, the old, females, and the mentally disabled. However, the relationship between disabilities and crime victimization received little attention until the 1960s when studies found high rates of developmental, physical, and behavioral disabilities among abused children (see, e.g., Birrell and Birrell, 1968; Elmer and Gregg, 1967; Gil, 1970; Johnson and Morse, 1968). Studies that followed also revealed higher than expected rates of substantiated child abuse among children with disabilities (e.g., Buchanan and Oliver, 1977; Frisch and Rhoads, 1982). These studies demonstrated a relationship between abuse and disability, but they shed little light on why the relationship might exist or whether disability was an outcome of or a risk factor for abuse. The traditional explanation for seemingly high rates of child abuse and other forms of violence against people with disabilities is referred to as the dependency-stress model. Used extensively between the 1960s and the 1990s, this model is fashioned on several premises: children with disabilities are more dependent on their caregivers; increased dependency increases the demands on caregivers; increased demands result in increased stress for caregivers; and caregivers abuse their charges because they cannot cope with the increased stress. Although this model appears to be logical, little research supports it, and some research seems to contradict it altogether (e.g., Benedict et al., 1992; Pillemer and Finkelhor, 1989; Starr et al., 1984). Furthermore, the model can be construed as excusing offenders or even transforming them into victims while blaming the real victims for causing stress.

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Page 24 THE MULTIFACTORIAL MODEL OF VIOLENCE In the past 40 years, researchers, family members, caregivers, and others have gained better understanding of the cognitive and physical abilities of people with developmental disabilities. As many of them have moved from institutions to partly and sometimes almost fully independent lifestyles, researchers have gained a broader understanding of the complexity of violent victimization within this population and a view that no existing model fully explains why these individuals are victimized. In their paper written for the workshop, Sobsey and Calder propose that explaining victimization requires an examination of a number of factors. Their multifactorial model synthesizes existing models and elements, drawing specifically on three models from other domains: (1) the counter-control model, which is used to analyze social interaction in behavioral psychology; (2) the lifestyles or routine activities model, which is frequently discussed in criminology; and (3) the ecological model, which is commonly used in discussions of child abuse. In addition, their model incorporates victim-related factors, offender-related factors, relationship factors, and environmental factors. The following section summarizes these models from other domains and suggests their relevance to people with disabilities, then explains the additional factors that make up the multifactorial model. Contributions from Other Domains Counter-Control Model According to the behavioral model of counter-control, when one individual exerts control over another, the second individual responds with counter-control. Thus, victimization can be predicted on the basis of the relative power of individuals and groups of individuals. From this perspective, people with disabilities would be victimized more frequently than others because they lack power and are less successful at recruiting assistance from more powerful protectors. Routine Activities or Lifestyle Model The premise of routine activities or lifestyle model is that the characteristics of potential victims influence role expectation and structural constraints to which they must adapt. These adaptations combine with the

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Page 25 role of expectations and structural constraints to influence daily routines or lifestyles. Lifestyle, in turn, determines the degree of exposure to potential offenders—the greater the exposure, the greater the risk of victimization. The model identifies several conditions that must occur for a crime to take place: exposure of the potential victim to the offender, motivation to commit the crime by the potential offender, a willingness to use criminal means to attain that end by the potential offender, and the potential offender's belief that the desired end can be achieved without paying too severe a penalty. This model suggests a number of possible explanations for the risk of victimization of people with disabilities. For example, institutional care may function both to increase the exposure of people with disabilities to potential offenders and may isolate them from sources of protection, such as the police. An offender may choose an individual with a disability as a victim out of a belief that apprehension is less likely and that punishment will be less severe if apprehension occurs. Combining the counter-control theory with this lifestyle model raises the hypothesis that institutionalization not only increases exposure to risk, but also increases the power differential by defining the roles of people with disabilities and staff in a manner that magnifies power differences. The Ecological Model The ecological model was developed by Bronfenbrenner (1977) to analyze child development. Used extensively to analyze healthy and abusive relationships between children and their caregivers, it provides a framework to analyze abuse of children with disabilities and violence against adults with disabilities. According to this model, violence or abuse is one form of interaction between two individuals—the offender and the victim. Their relationship is referred to as a microsystem—the child with a disability and his parent, the adult with a disability and his or her personal care provider. The model stresses that this relationship exists with and is strongly influenced by a unit of the social environment—a family, a group home, an institution—that is in turn strongly influenced by the society or culture. The attitudes and beliefs of a culture, for example, might determine whether or not an act is considered to be a crime, the priority it will be given for investigation, and the severity of the sentence that might be applied. A variation of the ecological model has been adapted to explain victimization of people with disabilities (Sobsey, 1994).

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Page 26 Components of the Multifactorial Model The multifactorial model expands on the ecological model by incorporating the counter-control and routine activities models. The potential victim, the potential offender, inhibition and disinhibition within the offender, interactions between the potential victim and potential offender and the relationship that determines those interactions—social control agents, the environment in which interactions occur, and the culture of the society that influences every interaction within it—these are the primary components of the multifactorial model and the primary factors that contribute to the increased risk of violence experienced by people with disabilities. Victim-Related Factors In attempting to understand why individuals with disabilities are victimized, some prefer not to examine the role of the victim, believing that such an examination shifts blame from the offender. Victimology, the study of the characteristics and behavior of people who are victimized, is relevant, however, for several reasons: evidence that blaming the victim is common is considerable; total denial that victim attributes and behavior influence risk suggests that individuals are powerless to reduce their risk; and evidence shows that factors such as age, gender, lifestyle, socioeconomic status, and disability affect the risk of victimization. Thus, exploring and understanding the reasons for differential risk may help to reduce risk for vulnerable members of society. Direct Effects of Disability A disability can directly affect the capacity of individuals to protect themselves, to avoid or escape from victimization, and to seek help. Some disabilities also increase dependency on caregivers. These effects of disability in increasing risk are minimal for very young children (because all young children are extremely limited in these abilities), but they become increasingly important in older children and adults. In addition, some disabilities impair judgment. People with developmental or psychiatric disabilities often have difficulty identifying when to be compliant and when to assert themselves. As a result, they may be victimized both when they comply too easily and when their refusal to comply provokes retaliation.

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Page 27 Socially Mediated Effects of Disability People with disabilities are often taught unquestioning compliance but rarely taught assertiveness and choice making. In addition, Sobsey and Calder maintain, they are rarely taught their human and civil rights; frequently taught to respond in the same way to a large number of caregivers rather than distinguishing family members and others from strangers; often denied appropriate sex education; often taught passive communication strategies but few social control functions; and often taught through physical prompting that does not allow for the development of an age-appropriate sense of personal space, which may be perceived as vulnerability by sexual offenders. These teachings or omissions in education put individuals with disabilities at risks that are not inherent to the individual or the disability. Victim Precipitation Victims sometimes exhibit behaviors that elicit violence on the part of the perpetrator. This does not mean, however, that the violence is justified by the behavior or that the violence was intended to be criminal. For instance, an individual with a developmental disability was beaten by police when he was mistaken for a robber who was resisting arrest because he did not communicate with the arresting officers (St. Louis Post-Dispatch, 1998). Persons with developmental disabilities may have difficulty recognizing situations in which danger exists and therefore may be less likely to take precautions. These victim-precipitation factors are likely to interact with offender disinhibitions, particularly when the atypical behavior associated with some disabilities requires caregiver intervention. Attractive Victims Although perceived vulnerability is a factor in the selection of an individual with a developmental disability as a victim, vulnerability by itself is rarely, if ever, sufficient to motivate a crime. The potential victim must have something the offender wants or have the ability to produce an event the offender finds desirable. Motivating factors include: Control over the victim. Many crimes against people with disabilities are related to coercion or punishment in an effort to gain control over the victim's behavior (see, e.g., Cincinnati Enquirer, 1997; Hartford Courant, 1998). Sex. Sexual offenses against people with disabilities appear to be common. In some cases, offenders have a special sexual attraction to people

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Page 28 with specific disabilities. Others may have a need to direct sexual aggression toward individuals they consider to be vulnerable. Money. In some cases, people with disabilities may stand between offenders and a large amount of money. Caregivers of individuals with disabilities have been known to kill their charges to gain control of money left by parents for the ongoing care of their offspring; medical negligence or other court awards; insurance settlements; life insurance policies; social security benefits; and the like (see, e.g., Norton, 1994). More commonly, however, such caregiver-offenders simply keep their victims alive in a state of fear and neglect, making money by collecting rent and other fees from them. Few alternatives to exploitation. Victims of violence who have disabilities sometimes allow themselves to remain in risky situations or to be victimized because life offers them few alternatives. For example, an abusive caretaker may be retained because no one else can be found. Offender-Related Factors In many instances, offenders target individuals with developmental disabilities because of their perceptions of them as vulnerable, their personality profile, or their lack of training in the care of individuals with disabilities. In addition, some offenders are themselves afflicted with a developmental disability. Specific offender-related factors in the victimization of people with developmental disabilities are discussed in the following sections. Perceived Vulnerability The perception that disability increases vulnerability may add to the risk of victimization. Perceived vulnerability refers to the potential offender's estimation of a potential victim's vulnerability. It may be based, in part, on actual vulnerability or on a misperception of vulnerability. In either case, an attractive victim is one who appears vulnerable to the offender. Media portrayals of people with disabilities may add to this perception of vulnerability (see, e.g., Senn, 1988). Some movies portray persons with a vision, hearing, or other disability as helpless victims of predators. Profiles of Offenders Some authors suggest that at least some offenders against people with developmental disabilities fit specific profiles. Sobsey (1994) outlines two basic profiles for caregiver offenders, and MacNamara

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Page 29 (1992) lists a number of possible patterns. These profiles apply mainly to paid and volunteer caregivers. One study found that 44 percent of the offenders in its sample against people with disabilities made initial contact with their victims through the web of special services provided to people with disabilities (Sobsey and Doe, 1991). Predatory Caregivers Predatory caregivers seek or maintain employment as caregivers in order to have access to victims. These individuals typically commit offenses with greater elements of planning and organization, although they may also commit impulsive offenses if their authority is threatened. Their offenses may include extreme physical or sexual violence or may be limited to simple harassment and degradation of the victim. The profile of many of these offenders is an individual with overwhelming feelings of inadequacy, lack of control over others, and an overwhelming need to assert control over others seen as vulnerable. For these offenders, control can take the form of bondage, torture, sexual assault, or a variety of other actions. Corrupted Caregivers This type of caregiver typically does not plan to offend. Under some conditions, they may even be acceptable or very good caregivers. Lack of adequate training, supervision, or dear policy results in the development of abusive patterns of interaction by these individuals. At some point in their caregiving activities, most caregivers experience inappropriate feelings—anger or even sexual attraction toward a client. Most recognize that acting on those feelings is wrong, but some will cross the boundaries into offensive behavior. Often these offenders are corrupted gradually, in stages, but sometimes the deterioration is sudden—for instance, a resident with a disability slaps or spits at the caregiver and the caregiver explodes into a violent rage. Offenders with Disabilities Sometimes crimes against people with disabilities are committed by others with disabilities. Much of this can be explained by a lifestyles exposure model, that is, the clustering of people with disabilities into group living situations increases the exposure of potential victims with disabilities to potential offenders with disabilities. Two mechanisms may increase offensive behavior on the part of some people with disabilities. First, residents who have been abused by staff may go on to abuse other residents. Second, some disabilities result in damage to areas

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Page 30 of the brain that control impulsive behavior, which can lead directly to lack of inhibition and a greater probability of offending. Relationship Factors Many individuals with developmental disabilities must depend on caregivers to a greater extent than other individuals of a similar age. This dependence on others may result in power inequities, and power inequities tend to increase the possibility of abuse (Sobsey, 1994). In addition, people with disabilities may be exposed to a large number of caregivers because of the care requirements of the disability and the turnover in staff of service delivery systems. Exposure to large numbers of caregivers increases the risk that at least one may become abusive (Sobsey, 1994). Healthy bonds with family members and other intimates provide a significant barrier to abuse and violence. Circumstances that commonly accompany disability may threaten or disrupt attachment and bonding. For instance, treatment of health problems may limit parent-child interactions. Moreover, parents are often implicitly and sometimes explicitly told that it is better not to get too attached to a child with a disability and that such a child will strain their marriage, career, happiness, and sanity. These negative expectations may interfere with parent-child bonding. Environmental Factors Environmental factors can both lead to developmental disabilities and increase the risk of violence against those with disabilities. Sobsey and Calder noted as examples the following environmental factors: Many people have disabilities that result, in whole or in part, from violence or severe neglect that caused physical damage or permanent neurological changes. Often such violence comes from the victim's own family or community and, unless the victim is removed, continues to put him or her at risk. Children born to mothers with severe substance abuse problems or who have endured spousal abuse during pregnancy may be likely to be born with developmental disabilities. Children born into families in which violence was present before their birth are more likely to become abused children. Families of people with disabilities may become isolated from their

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Page 31 communities and extended families, which increases the risk of violence. Group homes and institutions can also be isolating. Alternative living situations may cluster vulnerable individuals with those who are likely to abuse them without providing safeguards against victimization. Foster care homes, group homes, and institutions have all been found to increase the risks of victimization compared with typical natural families. Adults, adolescents, and even some children without disabilities have often been able to escape from abusive living alternatives by making other life choices. People with disabilities are often prevented from making such choices. Disabilities affect routine activities and exposure to high-risk environments. Many people who have development disabilities do not drive and are therefore much more likely to rely on mass transportation, walking, or others to get where they need to go. One study analyzing patterns of the sexual abuse of children with disabilities and the sexual assault of adults with disabilities found that 5 percent of offenses were committed by specialized transportation providers and 10 percent of offenses took place in vehicles (Sobsey and Doe, 1991). In addition, people are often committed to institutional care because they are unable to look after themselves or because they are dangerous to others. As a result, possible victims and prospective offenders are placed in close proximity with inadequate safeguards. A STARTING POINT This chapter presents a model developed by Sobsey and Calder to explain the perceived disproportionate victimization of people with developmental disabilities. They suggest a long list of potential mechanisms that may contribute to the increased risk of violence and abuse for people with disabilities. The list is not comprehensive and the research that supports it is limited, but the mechanisms described here do represent a starting point. In their paper, Sobsey and Calder conclude that research would be required to determine which of these—or which other—mechanisms play a significant role in the victimization of people with disabilities.