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6

Treatment Issues

As this report notes, almost no research exists on the impact of victimization on people with developmental disabilities or on the type of treatment or programs that would be most helpful to them. In an effort to examine the social service system response to crime victims with disabilities and how that response can be improved, the National Research Council asked Nora Baladerian, a clinician with extensive experience in treating persons with disabilities, to write a paper on these issues. This chapter is based on that paper, which was drawn from her clinical experience. Baladerian views the lack of research on these matters as a barrier both to preventing victimization of persons with developmental disabilities and to improving services for them.

Victimization may affect people with developmental disabilities at least as powerfully as the rest of the population, and perhaps more so. Because of a lack of preparation, information, education, and support, it is likely that in an assault, confusion may heighten terror, and may cause greater levels of distrust, depression, anxiety, and the other well-recognized responses to trauma among people with disabilities. The personal impact of maltreatment for a child or adult crime victim may depend on any of several important factors: the role of the perpetrator vis-à-vis the victim; the number of attacks; the response of the family and others to warning of the attack; and the time and choice for future activities allowed the victim. Because the perpetrator is most likely to be someone in a position of trust or perhaps of love with the victim with a disability, the closer the relation-



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Page 57 6 Treatment Issues As this report notes, almost no research exists on the impact of victimization on people with developmental disabilities or on the type of treatment or programs that would be most helpful to them. In an effort to examine the social service system response to crime victims with disabilities and how that response can be improved, the National Research Council asked Nora Baladerian, a clinician with extensive experience in treating persons with disabilities, to write a paper on these issues. This chapter is based on that paper, which was drawn from her clinical experience. Baladerian views the lack of research on these matters as a barrier both to preventing victimization of persons with developmental disabilities and to improving services for them. Victimization may affect people with developmental disabilities at least as powerfully as the rest of the population, and perhaps more so. Because of a lack of preparation, information, education, and support, it is likely that in an assault, confusion may heighten terror, and may cause greater levels of distrust, depression, anxiety, and the other well-recognized responses to trauma among people with disabilities. The personal impact of maltreatment for a child or adult crime victim may depend on any of several important factors: the role of the perpetrator vis-à-vis the victim; the number of attacks; the response of the family and others to warning of the attack; and the time and choice for future activities allowed the victim. Because the perpetrator is most likely to be someone in a position of trust or perhaps of love with the victim with a disability, the closer the relation-

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Page 58 ship, the more devastating the impact of the abuse. Betrayal can lead to an inability to regain trust, including trust of oneself. Both in child abuse and sexual assault, the response of others upon learning of the assault has been identified as a critical factor in healing the victim. When the family and others dose to the victim have a negative reaction, blame the victim, do not want to ever talk about what happened, do not believe that it happened, or protect the perpetrator, the results are psychologically devastating and set up a poor prognosis for the victim's ability to heal from the trauma. How the case is handled by the law enforcement agencies also has a powerful impact on the victim. How victimization affects an individual may depend on these significant factors: If the victim feels responsible for the crime or participation in the crime; If, prior to the attack, the victim had poor self-regard as a chronic or temporary state of mind; If the immediate response to the learning of the attack is empowering and supporting; and If she is informed that many women become victims of assault and that this did not happen because of who she is, but because the perpetrator is a person of bad intentions and a criminal. In assessing a crime victim for adjudication or mental health treatment, an understanding of these factors is critical. The individual's self-image and sense of empowerment or dependence will affect her experience and self-explanation of the crime. Rape trauma syndrome and post-traumatic stress disorder (PTSD) are well recognized as encompassing the range of normal psychological responses to trauma. Victims of sexual assault have more intense and perhaps more frequent physical reactions than those of victims of other types of crime. Physical changes that are obvious are changes in eating and sleeping routines, mood changes, and an overall level of more neediness (for children, a reversion to an earlier stage of life that required great nurturing and attention). In addition, crime victims may run away; stop eating altogether; eat only certain foods or a certain type or consistency of food; refuse to change clothes, bathe, or wash hair; cut hair; become aggressive or sexualized; begin sexual self-stimulation or mutilation; acquire or request change in hair color, tattooing, piercing,

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Page 59 type of clothing; reenact the crime; or become extremely overweight or dangerously underweight. The family will most likely become secondary trauma victims, exhibiting similar responses as described in PTSD, including depression, anxiety, rage, denial, and reliving the event based on what they have learned. Changes in the victim's personality can be expected, usually for the worse. The individual can be expected to withdraw socially, become irritable, and perhaps initiate the use of profanity or sexually related words or phrases. She can become obstinate, stubborn, demanding, or noncompliant and have a “don't care” attitude. Or she may simply withdraw and refuse to speak to anyone or participate in any social activity. TECHNIQUES THAT HELP ABUSE AND CRIME VICTIMS Psychological treatment and psychiatric treatment are important to the healing process for any victim, according to Baladerian, and thus for the crime victim with a disability. In many cases, no qualified practitioner is available for either individual or group treatment for victims with disabilities. Involvement of the family members in the treatment is a critical aspect to working with crime victims with developmental disabilities. Baladerian indicated that very few mental health practitioners demonstrate an interest in treating crime victims with a disability and that an exploration into motivating interest in such treatment is needed. Why mental health providers do not acquire training in this specialty may be a function of the general societal lack of interest in people with disabilities, Baladerian noted. Most people agree that the majority of people involved with disability issues, regardless of the field of endeavor, have taken an interest because of a personal experience. Psychologists or other mental health practitioners who graduate from any college today are likely to have received one hour or less of training on treating people with disabilities. SERVICES FOR CRIME VICTIMS Victim's assistance programs pay for psychological counseling for crime victims in every state. Approximately 10 percent of crime victims request psychological assistance through this program. It may be that potential mental health clients are never informed of this option by law enforcement officials, or others responsible for informing crime victims of this program. Information on use by people with a developmental disability is unknown.

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Page 60 Because so few crime victims access the Victims of Crime Program, its under-use by people with developmental disabilities is likely to continue. Specialized services for victims with disabilities or generic services that include people with disabilities, are provided by a number of organizations, yet no data exist on either the presence of programs or utilization of rape treatment centers, national advocacy centers, government-sponsored child abuse counseling programs, and government-sponsored domestic violence programs. Vertical prosecution units—in which a single prosecutor handles the case from filing through sentencing hearing—might be enormously supportive to people with disabilities, noted Baladerian, but these are few and far between. Anecdotal evidence from such units suggest they result in an increase in convictions in crimes against people with disabilities. There are thousands of rape crisis centers and domestic violence shelters across the country, yet very few can accommodate the needs of women with developmental disabilities or mental retardation. This is definitely problematic, since it can be more difficult for women with developmental disabilities to leave abusive relationships and to find and then obtain services. Project Action is a program of the Seattle Rape Relief, Advocacy and Education that addresses sexual assault among people with disabilities. The mission of Project Action is to challenge the myth that people with disabilities are asexual, incompetent, and dependent. These myths are replaced with information and actions that support the empowerment and rights of people with disabilities. Project services include in-service professional training, case consultation, and resource referral, as well as providing direct services to people who have been victimized. The main focus is currently on providing community education to care providers because of the high demand for such programs. The training programs are presented in group homes and are tailored to the needs of each. Project Action services about 500 to 600 care providers a year across the state of Washington. ABUSE AWARENESS AND PERSONAL SAFETY PROGRAMS Baladerian notes that there appear to be few abuse awareness educational programs for people with developmental disabilities. She has found that some members of the advocacy and support community appear to be fearful that discussing crimes will induce untoward fear in the students. Others seem to believe that discussing sexual crimes will lead to sexual interest and thus to sexual activity, and the resultant “problems” this will

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Page 61 engender. Many members of the disability advocacy community thus have expressed strong reservations about conducting such educational programs. Some communities have, however, developed personal safety programs with good results. The Portland, Oregon, Police Department developed a unique personal safety training and police awareness training program for adults with developmental disabilities. Their goal was to help prevent victimization, and if it did occur, to educate the victims about reporting the crime. With funding from the Bureau of Justice Assistance, the Portland police developed the Safety Zone: Cops Talk curriculum, which incorporated 27 lesson plans on topics ranging from being safe on the bus to staying away from friends who use drugs and alcohol. The Police Bureau delivered the safety training to nearly 1,000 adults with disabilities and over 300 of their family members. The program evaluation demonstrates that, as a result of classes, students retained knowledge learned, made safer choices that may result in reduced victimization and criminal offending, and have improved relationships with police (the curriculum and evaluation are available at www.teleport.com/~police ). Baladerian concluded that children and adults with developmental disabilities, as well as their parents or care providers, should be provided information about abuse and criminal victimization. The curriculum should be adapted to the particular needs of the community and the audience. It is best if the curriculum includes at minimum: a protocol for planned repeated presentations, pre- and post-testing to evaluate effectiveness of learning, the inclusion of an individualized response plan, feedback from the com munity and program participants, a measure of effectiveness, and endorsement from local officials. BARRIERS TO RECEIVING SERVICES Many agencies, organizations, and even courts are not fully accessible to people with disabilities. These deficiencies should have been repaired by July 1994, which was the deadline for accessibility compliance with the Americans with Disabilities Act (ADA). In addition to the physical site being accessible, under ADA, services, materials, and communication must be available to people with disabilities. In this area as well, compliance is more the exception than the rule. Many services are, for the most part, not accessible to victims with disabilities, including mental health treatment for the victim or the

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Page 62 secondary victim; outreach efforts, such as public education seminars; and written materials for victims of crime who have disabilities. Shelters for battered women with disabilities are few. Many programs to teach risk reduction strategies are too complicated for many with cognitive disabilities and are administered only once. Worse, participation in risk reduction programs may result in a false sense of safety by participants and a conviction by parents that their child now can prevent or manage an attempted assault, when in fact they cannot. Baladerian noted that barriers to service delivery include lack of knowledge of the problem, lack of interest in the problem, lack of information on resources to gain skills, fear of additional administrative and fiscal responsibility, overwhelming workloads or overworked agencies, and a lack of understanding of the extent and impact of the problem. She suggested that facilitators of service delivery include free training to become ADA compliant, grants to make physical accessibility changes in the facility, additional finances for adding new populations to the client census, and opportunities to provide unique training and internship programs that offer the agency a way to distinguish itself from the other agencies and thus become a “gatekeeper” referral source.