An Exploratory Study on the Work of Independent Living Centers to Address Abuse of Women with Disabilities.

During the past 20 years, considerable research has been conducted on the problem of domestic violence in the United States. Researchers have studied causes of domestic violence, its effects on victims, and the effectiveness of various types of interventions with perpetrators and victims. However, a review of the literature found very little research on domestic violence against women with disabilities. The needs of women with disabilities are often an afterthought in the development of battered women's programs. Moreover, the needs of women with disabilities who are experiencing abuse are often not addressed by programs serving people with disabilities. This article focuses on the services of independent living centers (ILCs) to women with disabilities who are experiencing abuse.

Review of the Literature

Prevalence of Abuse of Women with Physical Disabilities

In one of the few studies to address violence against women with disabilities, Young, Nosek, Howland, Chanpong, and Rintala (1997) compared 421 women without disabilities to 439 women with physical disabilities. They found that 13% of the women with physical disabilities had experienced physical or sexual abuse during the past year. The most common perpetrator of physical abuse was a husband or live-in partner. These authors found the prevalence of abuse of women with physical disabilities by husbands or live-in partners to be similar to the prevalence of this type of abuse for a comparison sample of women without disabilities. However, women with physical disabilities experienced physical or sexual abuse for a longer duration than women without disabilities (3.9 years vs. 2.5 years, U = 31529.5, p = .02).

Nosek, Walter, Young, and Howland (in press) found that women with disabilities have a significantly larger number of abuse perpetrators (M = 3.15, SD =2.16) than women without disabilities (M = 2.77, SD = 1.93), F (1,531) = 4.522, p = .034.

Schaller and Fieberg (1998) also studied the problem of abuse of women with disabilities. These authors found that the incidence of all types of abuse among women with disabilities cited in various studies ranges from 33% to 83%. According to their commentary, abuse by a spouse or intimate partner may have a negative impact on the woman's self-esteem and may also involve economic and social deprivation. The process of recovery from abuse involved re-establishment of a sense of control and safety.

These studies make it clear that women with disabilities are in need of abuse intervention services to the same extent as women without disabilities. In fact, they tend to have a longer duration of abuse. Moreover, they are subject to particular types of abuse, such as abuse by attendants and health care providers, which are less likely to occur to women without disabilities (Young et al., 1997). In addition, women with physical disabilities may have more difficulty obtaining help to deal with the abuse. They may lack information on domestic abuse services or existing services may be physically inaccessible. A woman with a physical disability may have transportation problems limiting her ability to access help. Her abuser may be the person who provides her personal care, thus she may fear losing her independence if she reports the abuse. Disability-related services are one of the few sources of help accessible to women with disabilities who are experiencing abuse. However, disability service providers may not be trained to address abuse and may lack information on local abuse intervention services (Young, Nosek, Walter, & Howland, 1998).

The Role of Rehabilitation Counselors in Addressing Abuse

Just as the literature on domestic abuse often fails to address the role disability may play in abuse, the literature on disability has done little to address abuse as an important issue for women with disabilities. However, as noted previously, research indicates that women with disabilities experience abuse at approximately the same rates as all women. A study by Berkeley Planning Associates (1996) found that the need for advocacy and protection against abuse by attendants was rated as a high priority by women with disabilities. Thus, the need to address the issue of abuse of women with disabilities is clear. Providers of disability-related services are in an ideal position to address this issue.

Young et al. (1998) discuss the role of rehabilitation counselors and independent living specialists in assisting their clients to deal with abusive situations. "As primary service providers to women with disabilities living in the community, rehabilitation counselors and independent living specialists have the opportunity to recognize abusive situations and to initiate the interventions that can bring about change" (Young et al., p. 8).

In a survey of 535 rehabilitation counselors and independent living specialists, the authors found that while 80% of respondents believed they had a responsibility to deal with their clients' abuse, only 19% routinely asked clients about family violence and other types of abuse. The authors also found a significant correlation (r = .43) between whether the respondent routinely asked about abuse and the percent of the respondents' clients who discussed abuse experiences. According to a study by Young et al. (1998), a substantial need exists for information and training on abuse by rehabilitation counselors and independent living specialists. In the study, 90% of the respondents indicated that they needed more information about abuse prevention and intervention, and 78% indicated that they would attend training on these topics if it were made available. The authors conclude that providers of services to women with disabilities need to be knowledgeable about abuse, be aware of and form working relationships with community resources for dealing with abuse, routinely include abuse safety screening in their intake procedures, and be able to provide information and referral to clients dealing with abuse.

Schaller and Fieberg (1998) also suggest that rehabilitation counselors are in a position to offer valuable assistance to women with disabilities who are being abused. The authors suggest that counselors help women develop safety plans and work with them to restore control over their lives. Counseling may involve assistance in meeting such needs as medical care, transportation, and attendant care. Vocational counseling may also be of value in helping the woman regain her independence.

Rehabilitation counselors provide professional services to assist women with disabilities with vocational assessments and other aspects of adjusting to their disability. Independent living centers (ILCs) often provide the ongoing support and assistance that these women need in order to live independently in the community. ILCs can be another important resource for women with disabilities who are experiencing abuse.

The Role of Independent Living Centers (ILCs) in Addressing Abuse

ILCs are non-residential community-based service organizations that work with people with disabilities who wish to live independently. ILCs differ from some other organizations serving people with disabilities because ILCs emphasize control of the organization by people with disabilities. The philosophy of ILCs is that people with disabilities are the ones who know best what they need to live independently (Berkeley Planning Associates, 1996). The consumer control philosophy of ILCs fits well with the grass roots approach of many battered women's programs. These programs often emphasize control and input by women who have experienced abuse. Thus, ILCs are philosophically in an ideal position to work with battered women's programs to improve services for women with disabilities who are experiencing abuse.

ILCs typically offer four core services: information and referral, independent living skills training, peer counseling, and advocacy. Through these core services, ILCs address many issues that affect people with disabilities, such as architectural barriers, obtaining and managing personal assistants, accessible transportation, and employment opportunities (ILRU Research and Training Center on Independent Living, n.d.). All of these core services are also essential in addressing the problem of abuse of women with disabilities (Berkeley Planning Associates, 1996). ILCs may provide information and referral to community abuse intervention resources, offer peer counseling to women with disabilities experiencing abuse, advocate for abuse intervention services to become more accessible, and offer independent living skills training to assist women with disabilities to leave abusive situations. A review of the literature found no references to the work of ILCs on the issue of abuse. However, two articles that are relevant to this topic discussed the role of ILCs in reducing the risk of secondary conditions among their consumers (Seekins, Clay, & Ravesloot, 1994; White, Gutierrez, & Seekins, 1996). The definition of secondary conditions used by these authors includes medical, environmental, and psychosocial factors that are not directly attributable to the primary disability, but may have a negative impact on the individual's health, functional capacity, and independence.

Seekins et al. (1994) mailed surveys to 456 individuals identified by three ILCs in rural Montana as having impairments that limited their mobility. Completed surveys were returned by 236 consumers. Respondents were asked to rate on a scale from 0 to 3 the severity of a list of 40 secondary conditions. The list of conditions included medical problems, such as joint pain, fatigue, and diabetes; psychosocial problems, such as depression, isolation, and substance abuse; and environmental problems, such as difficulties with access. A score of 0 indicated the condition had not been a problem; I indicated a mild or infrequent problem, 2 a moderate problem, and 3 a significant/chronic problem.

Based on this scoring, three measures of each secondary condition were calculated. The first measure was a frequency of endorsement. The second was an average severity rating. The third was a problem index score which was calculated by multiplying the average severity rating by the percentage of respondents endorsing the item. Of the 15 items with the highest problem index scores, 11 involved significant environmental or behavioral components, such as difficulties with access, depression, communication problems, and isolation. These results make it clear that environmental and behavioral factors have a major impact on the health and independence of people with disabilities. Based on results of this study, the authors suggest that rehabilitation practitioners should expand their role in the prevention of secondary conditions. While the list of secondary conditions in this study did not include abuse, abuse has a profound negative impact on many women, including those with disabilities. Abuse contributes to the development of secondary conditions such as injury-related medical problems, emotional problems, and loss of independence.

Given the role of ILCs in addressing secondary conditions, what might be an appropriate approach for ILCs in addressing abuse? According to White et al. (1996), ILCs typically provide direct support services as well as teaching consumers to identify and overcome environmental obstacles to the achievement of their goals. For example, ILCs might help consumers advocate for more accessible transportation or might teach skills for managing personal assistants. These authors suggest that ILCs have an important role to play in helping consumers prevent and manage secondary conditions. Some services that ILCs already offer, such as assertiveness training, peer counseling, and self-esteem building, may be particularly applicable to addressing abuse.

White et al. (1996) propose a model for addressing secondary conditions in the ILC setting. Components of their model include education and skill training, product/service availability, feedback, resource allocation, intersectoral collaborations, policy change, and environment and physical design. The authors suggest that these strategies can be applied to preventing the secondary conditions that affect the health and independence of ILC consumers. While the authors do not mention abuse as one of these secondary conditions, the components of their model could similarly be used to address the problem of abuse.

The purpose of the current study was to gather information on what services ILCs are offering to assist consumers who are experiencing abuse. Three research questions are addressed:

1. What are ILCs currently doing to address the issue of abuse of women with disabilities?

2. What are the components of an effective ILC program for addressing abuse?

3. How might ILCs develop and disseminate models for addressing abuse of women with disabilities?

Method

This exploratory study attempted to learn more about how ILCs are addressing the issue of abuse. There were three components to the study. First, a survey regarding work on abuse was mailed to all of the 579 ILCs in the United States. The survey indicated that the researchers wanted to learn how ILCs were addressing abuse with their consumers. Staff of ILCs were requested to contact the researchers by toll-free phone number or e-mail to talk about their current abuse-related services and whether they would like to expand those services. Second, in-depth interviews were conducted with staff of two ILCs that have well-developed programs for abuse intervention. Finally, four programs were selected to receive technical assistance grants to assist them in expanding their work on abuse and in developing models for use by other ILCs. ILCs that responded to the survey were not aware of the availability of these technical assistance grants. Grantees were selected after the survey was completed.

In order to ascertain how ILCs are currently addressing abuse with their clients, a survey was sent to a mailing list obtained from the Independent Living Research Utilization program at The Institute for Rehabilitation and Research. This mailing list included all of the 579 ILCs in the United States. Those receiving the letter were asked to respond by telephone (toll-free) or e-mail to four questions:

1. What is your level of interest in expanding the services of your independent living center to include abuse counseling and referral?

2. Do you have a staff member who has special expertise or experience in abuse?

3. How often do you offer information about abuse and refer consumers to local abuse service organizations?

4. Are there any activities that you conduct in collaboration with your local battered women's programs?

ILC staff who responded by e-mail were contacted for a telephone interview. Those who called were referred to research staff for telephone interviews. The questions listed above were used as a general guide when interviewing respondents. Respondents were also encouraged to expand on these questions by identifying other abuse-related issues and concerns.

In addition to those who responded to the survey, in-depth interviews were conducted with staff of two programs previously identified by the researchers as offering comprehensive services for addressing abuse with their clients. In addition to the tour questions previously listed, these respondents were asked to address several other questions:

1. What motivated the program to begin addressing the issue of abuse?

2. What were the initial steps in developing a program to address these issues?

3. How did they fund their efforts?

4. How did their services expand?

5. What services are they currently providing?

6. Of the services offered, which do they believe have been the most successful and had the most impact?

7. What more would they like to do in the future?

8. How do they interact with the battered women's movement in addressing abuse?

Responses were analyzed and summarized to identify the range of services being offered and the most common needs and problems encountered.

Results

Interviews were conducted with 36 ILC staff who responded to the survey and 3 staff of 2 additional ILCs that were known to the researchers as having comprehensive abuse-related services. Analysis of the responses provided information on what abuse-related services were being offered by ILCs, and what needs and problems ILC staff had encountered in attempting to assist consumers who were experiencing abuse.

Survey of ILCs

Of the 579 ILCs to which we sent a survey, 36 responded. Because this study was exploratory, 36 informants were considered a sufficient number to gather the information the researchers were seeking. Research staff conducted telephone interviews with one staff member from each of these programs. Respondents represented all geographic areas of the country including both urban and rural programs, and varied in size from small programs with only one or two paid staff to large programs with many staff and several program components. Characteristics of the programs are described in Table 1.

Table 1. Demographic Characteristics of Respondents

                        No. of Programs

Service Area
Urban                         13
Rural                          7
Both urban and rural           2
Unknown                       14

Geographic Region
Midwest                       15
Northeast                      8
Northwest                      2
Southeast                      4
Southwest                      1
West                           5
Unknown                        1

Respondents also varied widely in the extent of their work on abuse. Some were not addressing the issue at all, while others were doing extensive work on it. Five respondents reported that they rarely see abuse as an issue with their clients, but most programs identified abuse as a major issue hat needs to be addressed. Thirteen programs reported having at least one staff person with expertise on abuse.

ILCs reported addressing abuse with clients in a number of ways (see Table 2). The most frequent means of addressing abuse was through referral to abuse intervention programs. Nineteen programs (52.8%) reported offering such referrals. Another frequent means of addressing abuse was offering training on disability issues to other service providers who might have contact with women with disabilities experiencing abuse. Thirteen programs (36%) offered such training. Other abuse-related services mentioned by more than one program included advocacy for improved access and support services by abuse intervention programs, individual or group counseling provided by the ILC, training on abuse for ILC staff, and involvement of ILC staff in interagency efforts to address violence in the community.

Table 2 Independent Living Center Program Activities to Address Abuse Issues

Type of Activity                                          Number of
                                                           Programs
                                                            Offering
                                                       This Activity

Services and Resources Offered to Consumers

 Referrals to and from abuse intervention                      19
 programs

 Staff person with abuse expertise                             13

 Individual counseling for abuse issues                         5

 Support groups addressing abuse issues                         4

 Materials on abuse issues available in                         1
 resource library

 Support for women with disabilities while in                   1
 shelter

 Availability of medical equipment and                          1
 assistive devices for loan to women while in
 domestic violence shelter

 Collaboration with abuse intervention programs                 1
 to provide accessible transitional housing

Training, Advocacy, and Outreach

 Training other service providers on disability                13
 issues

 Advocacy to improve access to battered women's                 7
 shelters and abuse intervention program offices

 Cross-training with domestic abuse and sexual                  6
 assault programs

 ILC staff serving in interagency efforts to                    5
 address violence, e.g. family violence councils

 Advocacy for support services such as interpreters             3
 for hearing-impaired women and personal
 assistants for women while in shelter

The programs who responded to the survey mentioned a wide range of needs and problems that they had encountered in addressing the issue of abuse with women with disabilities (see Table 3). These needs and problems fell into four categories. First, there was an awareness that women with disabilities face particular vulnerabilities to abuse. These vulnerabilities include abuse by a family member on whom they are dependent for financial support, personal care, or both; abuse by personal assistants; and abuse in institutional settings. Women with disabilities may also encounter specific problems when trying to escape an abusive situation in their homes, such as increased isolation, greater difficulty with self-defense, and loss of needed medications or assistive devices.

Table 3 Needs and Problems Mentioned

Item                                                Number of
                                                programs mentioning

Specific vulnerabilities to abuse due to
disability

  Dependence on abusive family member for                         6
  economic support and/or personal care
  Abuse by personal assistants                                    3
  Abuse in residences and nursing homes                           2
  Isolation                                                       1
  Loss of medication or assistive devices                         1
  when leaving abusive situation
  Self-defense more difficult                                     1

Problems needs within independent living
centers

  Inadequate staff time                                           3
  Inadequate funding                                              3
  Need more training on abuse issues                              3

Problems or needs with other service providers

  Improved physical access to shelters and other                 13
  abuse intervention programs
  Abuse intervention programs need to do specific                 6
  outreach to women with disabilities
  Refusal to allow or provide personal assistants                 4
  women residing in shelters
  Lack of accessible transportation in order to                   3
  access abuse intervention services
  Lack of sensitivity to disability issues by                     3
  services providers, e.g., 911 personnel, law
  enforcement, medical professionals
  Need better coordination of services among                      3
  providers
  Lack of interpreters for hearing-impaired women                 2
  Abuse intervention staff and other service                      2
  providers need training on disability issues
  Respite care when the abuser has been the care                  2
  provider
  Lack of abuse intervention services for homebound               1
  women
  Need for support services such as counseling, job               1
  training, and independent living skills training for
  women with disabilities residing in shelters
  Accessible transitional housing for women with                  1
  disabilities when they leave shelters
  Funding for housing modifications for women                     1
  leaving their homes due to abuse

Second, ILC staff mentioned a number of problems that women might encounter in seeking help from abuse intervention programs or other service providers. The most frequent problem mentioned was physically inaccessible shelters and abuse intervention program offices. Thirteen of the respondents had encountered this problem. Other problems mentioned included difficulty in obtaining personal care assistance while in a shelter; lack of interpreters for women with hearing impairments; lack of accessible transportation to the shelter or abuse program; and insensitivity of other service providers, such as 911 staff, law enforcement officers, and medical professionals.

ILC staff also mentioned a need for increased outreach to women with disabilities who might be experiencing abuse. Some respondents felt there was need for better coordination of services among service providers and for more training of service providers on disability issues. One respondent suggested that women with disabilities would benefit from support services provided in shelters, such as counseling, job training, and independent living skills training. It was suggested that ILC staff could collaborate with shelters in providing these services.

Third, respondents recognized that while many problems exist in the response of abuse intervention programs to women with disabilities, there are also problems with the response of ILC staff to women experiencing abuse. Three respondents acknowledged this inadequacy in ILC services. They attributed the lack to inadequate staffing, funding, and training on abuse.

Finally, a few respondents suggested a need for additional services that do not now exist. Two respondents suggested there is a need for respite care in situations where the abuser has been the caregiver. Two respondents mentioned a need for accessible housing for women with disabilities who are leaving their homes due to the abuse.

Comprehensive Independent Living Center Abuse Intervention Services

In addition to the nationwide survey, qualitative interviews were conducted with staff of two independent living centers that are making comprehensive efforts to address abuse of women with disabilities. The two programs were chosen through consultation with leaders in the independent living and domestic violence movements. They were chosen due to the comprehensive nature of their approach to abuse. Two staff members of one program and one staff member of the other were identified to serve as key informants on the work of ILCs on abuse. The purpose of these qualitative interviews was to identify the components of an effective independent living center abuse intervention program. One of these centers has had an abuse intervention program for about 10 years. The other is just beginning work in this area. It has a 3-year plan for developing a comprehensive program. While the two programs profiled in these qualitative interviews differ considerably in program size, service area, and length of experience with abuse, a number of common themes emerged in the interviews.

First, for each program, development of abuse intervention services began when one staff member recognized abuse as a problem for ILC consumers. In one case, the initial recognition had to do with realizing the lack of accessible shelters for battered women with disabilities. In the other case it was the frequency with which women in support groups brought up abuse as a problem in their lives. These initial recognitions led to enlisting the support of other ILC staff in beginning to address abuse with their consumers.

Another common theme was the need to make a decision on how best to approach abuse intervention for women with disabilities. In both cases, it was decided that a multi-faceted approach was necessary. It was clear that, since the ILC was a common initial contact for women seeking support, ILC staff needed training in abuse intervention. However, staff of both programs also recognized that it was not the role of the ILC to provide a full range of abuse intervention services. Rather, an important component of their approach to abuse intervention was to collaborate with, and if necessary, challenge existing abuse intervention programs in order to make their services more accessible to women with disabilities.

Collaboration with existing abuse intervention programs took a number of forms. Cross-training proved to be an effective means of improving both the response of ILC staff to abuse and the response of abuse intervention staff to disability issues. Cross-referral between ILCs and abuse intervention programs helped women with disabilities to have access to a full range of services in addressing the interaction of abuse and disability issues. Outreach efforts by both types of programs enabled them to more effectively reach women with disabilities who were being abused. This collaborative effort proved to be a more effective means of improving services to women with disabilities than establishing a separate, ILC-based intervention program.

Another common theme that emerged in interviews with staff of these two comprehensive programs was the problem of accessibility in battered women's shelters. Coupled with this was the problem of inadequate funding for accessibility modifications. While the initial approach of ILC staff to abuse intervention programs was collaborative, there was also a need to challenge these programs to improve accessibility. One form this challenge took was educating programs on the requirements of the Americans with Disabilities Act (ADA). ILC staff also assisted shelters in identifying possible funding sources for accessibility modifications. While these steps were effective in some cases, in a few cases it was necessary to take legal action to enforce ADA compliance.

In addition to the problem of physical inaccessibility, another theme that emerged from the interviews was the importance of programmatic accessibility. A number of factors were mentioned under this category, such as provision of interpreters or telecommunication devices for the deaf (TDD) for women with hearing impairments, lack of understanding of invisible disabilities, and lack of understanding of the specific needs of women with physical disabilities. For instance, there was sometimes a reluctance to allow service animals or personal attendants to accompany women into shelters.

There was a need for education on the particular forms of abuse a woman with a disability might face, such as caregiver abuse and withholding of essential assistive devices or medication. There was also a need to educate abuse intervention staff on obstacles that a woman with a disability might face in leaving an abusive situation, over and above the obstacles faced by all women. A woman with a disability might have greater difficulty finding alternative housing and might be even more fearful than other women of losing the financial support provided by her abuser. In working with abuse intervention staff, ILC staff emphasized that addressing all of these issues was necessary for full accessibility of women with disabilities to abuse intervention services.

A final theme that emerged in these interviews was the need to educate not only abuse intervention staff, but also other service providers, on the issues facing women with disabilities experiencing abuse. ILC staff learned from their consumers that law enforcement, medical, and social service providers were often not sensitive to disability issues. ILC staff recognized that they needed to educate and advocate with these other service providers, as well as with abuse intervention programs, if women with disabilities experiencing abuse were to receive the intervention services to which they were entitled.

The final component of this study was selection of four ILCs from among those who responded to our survey to receive small technical assistance grants to expand their work on abuse. Funding for these grants was provided by the National Institute on Disability and Rehabilitation Research, United States Department of Education. The purpose of the grants was not only to assist specific programs, but also to learn more about the impact of various types of programming and to develop models and materials that would be useful to other programs. Respondents to the initial survey were not aware of the availability of grant funds until after interviews with their staff had been completed.

Selection of the grantees was based on their history of work on abuse and on their proposed use of the funding. An effort was made to select programs proposing a range of projects. There was also an intentional effort to select programs from urban and rural settings, and from different geographic areas. The selection process resulted in grant awards to two urban and two rural programs, I each from Ohio, Wisconsin, New Mexico, and Wyoming. Grants were for a 1-year period. At the end of the period, grantees provided detailed information on their activities and copies of materials they had developed so that this information could be disseminated to other ILCs for their use.

Discussion

Survey Responses

In interviews with both respondents to the national survey conducted for this study and with staff of two comprehensive ILC abuse intervention programs, it became clear that abuse is a major problem for women with disabilities. It also became clear that a multi-faceted approach is necessary in addressing the problem of abuse of women with disabilities.

First, because ILCs may be an initial point of contact for women with disabilities experiencing abuse, it is important that ILC staff recognize that abuse is a serious problem for women with disabilities. ILC staff are in a unique position to offer initial counseling and referral for their women consumers who are being abused. However, in order to offer these services effectively, ILC staff must be educated on abuse so they can create a safe environment for women to disclose abuse.

Second, inadequate staffing and funding were mentioned as a hindrance to addressing abuse, even by programs that are aware of the problem of abuse of women with disabilities. There is a need to assist ILCs in identifying sources of funding specifically for abuse-related services.

Third, there was agreement among survey respondents and interviewees that the most effective approach to addressing abuse of women with disabilities is usually not for ILCs to establish their own shelters and free-standing abuse intervention programs. One of the most important roles of ILCs is to assist and advocate for all of their consumers to utilize existing services, such as health care, housing assistance, and social services. This role includes not only educating consumers on what services are available, but also training providers of these services to be more responsive and accessible to consumers with disabilities. This approach, which is used to address many other problems of people with disabilities, is also, according to these respondents, the most effective approach to addressing abuse.

Another major theme was the value of strong collaborative relationships between ILCs and abuse intervention programs. Such collaboration might involve cross-training of staff, cross-referral between programs, outreach to women with disabilities experiencing abuse, and a role for ILCs in supporting women with disabilities who are utilizing shelter services. Respondents suggested that ILCs might offer assistance to shelters in obtaining personal assistants for women in shelters, replacing assistive devices or medications lost when the woman left home, and offering transitional services to assist the woman in establishing independence from her abuser.

Many respondents mentioned the necessity to educate a wide range of service providers on the needs of women with disabilities who are experiencing abuse. Abuse intervention involves a number of systems, including law enforcement, courts, health providers, and social service programs. An effective intervention approach requires that all of these systems work cooperatively. Community-wide collaborative efforts are becoming the standard for effective domestic abuse intervention. Yet, according to our respondents, many service providers are unaware of the specific needs of women with disabilities. ILCs have an important role to play in educating providers on disability issues and ways to address these issues.

Finally, almost all of our respondents mentioned lack of accessibility as a major problem hindering women with disabilities from dealing with abuse. While the Americans with Disabilities Act (ADA) has certainly had an impact on improving physical accessibility of public facilities, many shelters and abuse intervention programs are still not in compliance with ADA. Lack of funding is the reason usually cited for this lack of compliance. It is clear that, in order for ILCs to effectively serve women with disabilities experiencing abuse, they must take an active role in encouraging, and even sometimes insisting on, compliance with ADA by abuse intervention programs. ILCs can also be of great value in educating abuse intervention programs on the many components of full accessibility, such as sensitivity of staff to disability issues and provision of needed services, such as personal assistants and interpreters.

Technical Assistance Grants

Four ILCs, two urban and two rural, received technical assistance grants to expand their work on abuse. The grantees used the grant funding for a variety of purposes. Two programs conducted training with staff of local agencies who were like to encounter people with disabilities who were experiencing abuse. Training was conducted with domestic abuse programs, law enforcement, adult protective services, and emergency room staff. The focus of training was on improving the ability of service providers to meet the needs of people with disabilities seeking assistance with abuse. Training components included knowledge of disability issues and understanding how disability might affect a consumer's ability to access abuse intervention services.

Two programs used grant funds to develop printed materials. One printed and distributed two brochures, one on disabilities and domestic violence and the other on safety planning for people with disabilities who were being abused. Another developed two training manuals, one providing information on abuse for ILCs, and the other providing information on disability issues for domestic abuse programs. Copies of all printed materials were provided to the Center for Research on Women with Disabilities. Some of the materials have been incorporated into an Abuse Intervention Kit which is being distributed to ILCs nationwide.

One program developed a screening instrument to be used during ILC intakes to identify consumers experiencing abuse. At the beginning of the grant period, ILC staff identified three of their consumers as having problems with abuse. During the grant period, the screening instrument was used during intake with 84 consumers. Of those screened, 41 reported current or past physical abuse, 33 reported current or past sexual abuse, and 46 reported current or past emotional abuse. Based on these results, the ILC developed a program for consumers experiencing abuse, including counseling, information and referral, and abuse intervention services.

The grantee programs all reported positive results from projects conducted with grant funds. They reported having developed stronger collaborations with domestic abuse programs and other service providers, increased identification of consumers experiencing abuse, and improved services to these consumers. The work of the grantee programs provided models and materials that will be of use to other ILCs in addressing the issue of abuse with their consumers.

Limitations and Implications for Future Research

The results of the survey reported in this article cannot be taken as representative of the level of abuse intervention services provided by all ILCs. The study was exploratory in nature, designed to gather information on what some ILCs are doing to address abuse among their consumers. Due to the low response rate, survey results are not representative of how ILCs in general are addressing abuse. The information gathered does, however, provide valuable information on what types of abuse-related services are being offered in the ILC setting and what needs and problems ILC staff have encountered in addressing abuse.

During the past 20 years considerable progress has been made in addressing the problem of domestic abuse in the United States. Legislation provides better protection for battered women. Moreover, a wide variety of services have been developed to assist women experiencing domestic violence. Considerable work has been done to educate service providers and the community at large on the seriousness of the problem of domestic abuse. However, the needs of women with disabilities experiencing abuse have often been neglected in these efforts. There is a need for further research on the most effective means of meeting these needs.

References

Berkeley Planning Associates (1996). Priorities for future research: Results of BPA's delphi survey of disabled women. Oakland, CA: Author.

ILRU Research and Training Center on Independent Living (n.d.) An orientation to independent living centers [Brochure]. Houston, TX: Author.

Nosek, M. A., Waiter, L. J., Young, M. E., & Howland, C. Lifelong patterns of abuse experienced by women with physical disabilities. Journal of Interpersonal Violence.

Schaller, J., & Fieberg, J. L. (1998). Issues of abuse for women with disabilities and implications for rehabilitation counseling. Journal of Applied Rehabilitation Counseling, 29(2), 9-17.

Seekins, T., Clay, J., & Ravesloot, C. (1994). A descriptive study of secondary conditions reported by a population of adults with physical disabilities served by three independent living centers in a rural state. Journal of Rehabilitation, April/May/June, 47-51.

White, G. W., Gutierrez, R. T., & Seekins, T. (1996). Preventing and managing secondary conditions: A proposed role for independent living centers. Journal of Rehabilitation, July/August/September.

Young, M. E., Nosek, M. A., Howland, C., Chanpong, G., & Rintala, D. H. (1997). Prevalence of abuse of women with physical disabilities. Archives of Physical Medicine and Rehabilitation 78. Supplement, S-34 - S-38.

Young, M.E., Nosek, M. A., Walter, L., & Howland, C. (1998). A survey of rehabilitation service providers' perceived knowledge and confidence in dealing with abuse of women with disabilities. Manuscript submitted for publication.

Nancy P. Swedlund, Psy.D., Center for Research on Women with Disabilities, Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, 3440 Richmond Avenue, Suite B, Houston, TX 77046.