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End the silence: a survey of abuse against men with disabilities.

A growing body of research suggests violence and abuse are serious problems for women with disabilities, who are at greater risk than non-disabled women (Brown, Stein, & Turk, 1995; Curry, Powers & Oschwald, 2003; Hassouneh-Phillips & Curry, 2002; Hughes, Swedlund, Petersen & Nosek, 2001; Powers et al., 2002; Saxton et al., 2001; Sobsey & Doe, 1991; Turk & Brown; 1993; Young, Nosek, Howland, & Chanpong, 1997). The social context of disability, including factors such as poverty and social isolation, invalidation of the victim with disability, environmental inaccessibility, reliance on support from others, and perpetrator's perceptions of reduced risk of discovery, has a powerful impact on individuals' increased risk for violence (Andrews & Veronen, 1993; Hassouneh-Phillips, McNeff, Powers, & Curry, 2005).

Given that abuse against women with disabilities is such a serious problem, why has so little attention been given to investigating abuse against men with disabilities? This omission may be the result of a combination of factors. Fear of recrimination, dependence on the abuser and concerns about losing independence make both female and male victims reluctant to report abuse. Further barriers to abuse reporting by men with disabilities include predominant societal assumptions that men should be more capable than women of protecting themselves (Furey, 1994; Saxton, et al., 2006). Unlike the disabled women's abuse movement, there is not an organized effort among men with disabilities to bring attention to this problem. Finally, the lack of reporting or support services targeted to men may contribute to the minimization of the problem (Brown et al., 1995).

Throughout our investigation of abuse against women with disabilities (e.g., Curry, et al., 2003; Powers, et al., 2002; Saxton, et al., 2001), we were often asked why we were not studying abuse perpetrated against men with disabilities. Women and men with disabilities, as well as professionals, shared many stories of men being victimized by intimate partners and people who provided formal or informal personal assistance, suggesting violence is a serious issue for men with disabilities. The study described in this paper is an effort to begin addressing this void.

Background

Abuse of Men in General

Understanding of the problem of abuse against men with disabilities can be derived from current knowledge related to the abuse of men without disabilities as well as findings on the abuse experiences of men with disabilities. The only population-based survey of abuse of men comes from the National Violence Against Women Survey (Tjaden & Thoennes, 2000). A comparison group of 8,005 men completed a telephone survey about their experiences of rape, physical assault and stalking: 66% of the men reported physical assault as a child by an adult caretaker and/or as an adult by any type of perpetrator; 7.3% reported lifetime physical intimate partner violence and 3% reported an attempted or completed rape as a child or adult. Within the past year, 3% of the men reported a physical and/or sexual assault by an intimate partner.

Much of the research on violence against men has been conducted with subgroups, such as elder, gay and bi-sexual men. For example, The National Elder Abuse Incidence Study (Tatara, Kuzmeskus-Blumerman & Duckhorn, 1998), an analysis of adult protective services and other aging services records, documented that older women living in the community are significantly more likely than older men to experience all forms of abuse by others, controlling for the higher proportion of female elders in the population. Abuse was more likely to occur to elders who had difficulty caring for themselves. Interpretation of these findings is complicated by the possibility that older men with disabilities and those in their lives may have been reluctant to report their abuse. A second example comes from Ratner and his colleagues (2003) who administered questionnaires to 358 males between the ages of 19-35 that identified themselves as either gay or bisexual. The results indicated that 35% of the men experienced non-consensual sex, 14% reported that their first sexual assault occurred when they were 14 years of age or older.

Abuse of Men with Disabilities

Although some studies suggest that men with disabilities are less likely to be abused than women with disabilities (e.g., Allington, 1992; Sobsey & Doe, 1991; Turk & Brown, 1993), until recently, most research was confounded by a reliance on adult protective services (APS) abuse reporting information, which is typically provided by others rather than by the victim and may under-represent men who may be reluctant to report abuse. Despite this challenge, we are learning that abuse of men with disabilities occurs at alarming rates. Adult protective services (APS) abuse reporting data for people who experience cognitive disabilities, where mandatory reporting is common, suggest that men and women experience similar levels of abuse. In one study involving physical abuse, the male to female victim ratio was found to be 56% to 44% (Marchetti & McCartney, 1990). In their review of 85 confirmed cases of sexual abuse among persons with developmental disabilities living in staffed housing, Brown et al., (1995) found that men were as likely as women to be identified as victims. It is important to note that in studies suggesting women are more likely to be victimized than men, males with disabilities nevertheless constitute a larger percentage of victims than would be expected from studies of the general population (Sullivan, Brookhouser, Scanlan, Knutson, & Schulte, 1991).

Many men with disabilities require personal assistance services (PAS), assistance with tasks that individuals would normally do for themselves if they did not have a disability (Litvak, Zukas, & Heumann, 1987). The first study of PAS abuse involving men with disabilities was by Ulicny, White, Bradford and Mathews (1990). They surveyed 91 male and female users of 15 randomly selected independent living center attendant services programs. They found that 40% of the respondents reported financial abuse while 10% reported physical abuse. Twenty-five percent of the respondents reported they did not confront the PAS provider because of fear of retribution and 19% overlooked the exploitation to avoid having to locate a new provider. Commonly mentioned strategies to prevent theft included consumers keeping valuables under lock and key, carefully screening PAS provider applicants, regularly monitoring medications and bank accounts, and signing their own checks. The study did not differentially examine the experiences of men and women PAS users or other forms of abuse.

A second study of personal assistant abuse by Oktay & Tomkins (2004) surveyed 60 men and 24 women with spinal cord injury. They found that 30% of respondents reported abuse by their primary care providers and 61% reported abuse by other providers. Rates of abuse reported did not significantly differ by individual's gender or age. Those with lower incomes and those with male providers and providers who were inexperienced or worked more than 50 hours per week reported higher levels of abuse.

Abuse meanings and responses among men with disabilities. Our first study of men with disabilities (Saxton, et al., 2006) was a qualitative study of 78 men with physical and physical and cognitive disabilities designed to obtain more detailed information about the nature of abuse experienced by men, barriers to addressing abuse, and strategies for promoting men's safety. Focus group participants were recruited through disability organizations and agencies, independent living centers and self-advocacy groups. Verbatim transcripts were coded and analyzed using established ethnographic and content analysis techniques (Denzin & Lincoln, 1994). The participants reported similar forms of abuse reported by women with disabilities; they described examples of physical, sexual, and emotional abuse; manipulation of equipment and medication; financial theft/exploitation and neglect. Many men emphasized the abusive consequences of PAS providers failing to perform their duties and/or using drugs or alcohol on the job, as well as mistreatment by service agency staff that they characterized as unresponsive. Several of the participants highlighted the inevitability of abuse, a general lack of societal recognition of the problem for men, and their reluctance to disclose abuse because they are expected as "men" to manage the problem themselves and not to "squeal." Many men discussed the need to balance trade-offs between addressing abuse, on one hand, and experiencing other negative consequences, such as having no back-up personal assistance, being institutionalized, facing retribution from the perpetrator, and being ignored by an unresponsive service system as the alternative. Abuse management strategies described by participants included being able to select, train and supervise their PAS provider, maintaining control in their PAS relationship, having peer support and access to back-up PAS, and community outreach to increase awareness of and support for abuse against men with disabilities.

Study Purpose

The purpose of this survey study was to build upon the findings from our qualitative study by investigating the experience of various forms of typical and disability-related abuse by men with disabilities, which abusive behaviors men considered most harmful, which barriers men perceived as creating the greatest obstacles to addressing PAS abuse, and which strategies men perceived as most helpful for preventing or ending PAS abuse. The following research questions were examined:

1. To what extent do men with disabilities experience abuse, including abuse by personal assistance services providers?

2. What forms of personal assistance abuse do men with disabilities consider most hurtful?

3. What are the most critical barriers that impede men's handling of personal assistance abuse?

4. What are the most important strategies that men others can use to prevent and/or stop personal assistance abuse?

We were also interested in understanding the extent to which factors such as type of disability, age of disability onset, marital status, ethnicity, relationship of PAS provider and provider payment had an impact on men's abuse experiences.

Method

A survey design was used to collect the data. The majority of the survey interviews were conducted by telephone; a few in-person interviews were conducted to accommodate the participants' disabilities.

Participants

Three hundred forty-two men, 18 years of age or older, with physical disabilities or physical and cognitive disabilities were recruited through regional durable medical equipment (DME) suppliers serving individuals in Oregon, Washington, and the San Francisco Bay Area, and developmental disabilities services organizations and agencies in Oregon. Men who lived in non-congregate community residences and used personal assistance services provided by family members, friends or paid personnel at least 3 times per week were invited to participate. Men's experience of abuse was not a requisite for participation.

Procedure

Durable medical equipment suppliers performed computer sorts of their databases to identify all adult male customers with IDC-9 diagnostic codes reflecting long-term disability (e.g., spinal cord injury, multiple sclerosis, cerebral palsy) who had purchased mobility-related durable medical equipment within the past year. DME suppliers were selected as our primary recruitment sources because they serve individuals with long-term physical disabilities, regardless of whether they receive public or private disability benefits or services. In contrast to recruiting participants primarily through independent living centers and disability agencies, as was done for our survey of disabled women's abuse experiences (Powers et al., 2002), we thought recruiting through DME suppliers would be more likely to involve participants who used informal PAS.

DME suppliers mailed an information packet to approximately 2800 men identified as meeting the criteria for study participation. The packet included an invitation to participate in the study, a study flyer, a stamped, return postcard to complete if they wished to participate, and a wallet-sized card that listed violence resource information for men. For safety reasons, the mailed materials described the study as investigating men's experiences using personal assistance rather than specifically referring to abuse and the informed consent was not included in the packet. The return postcard asked men to identify the language preferred for their telephone interview, any accommodations needed, and whether they would like to receive $20 for participating in the study.

In response to the DME mailing, 313 postcards were sent to the Portland State University Survey Research Lab (SRI), a response rate of 11%. Although low, the rate is within the norm for the general mail-out methodology used. Men who returned interest postcards were contacted by a trained SRL telephone interviewer to confirm their interest in and eligibility for the study, and to schedule a telephone or in-person administration of the survey at a convenient, safe time and location. Only 20 men who returned postcards were not surveyed, either because they were subsequently determined not to be eligible for the study (did not use PAS), they elected not to participate once contacted, they were deceased, or they were not reachable at the contact number provided. The majority (N=293; 93.6%) of men who returned postcards completed the survey, primarily by telephone. A few participants were interviewed in person to accommodate their disability. Participants indicated their consent in two stages; initially by mailing their interest postcards and then by giving verbal consent over the telephone after the informed consent was read to them. Mandatory abuse reporting requirements were carefully explained to all participants. Consent forms were mailed to participants who indicated it would be safe.

To ensure their participation, men who received developmental disabilities services were personally invited to join the study by representatives from developmental disabilities agencies, organizations and self-advocacy groups in Oregon and the San Francisco Bay Area. Men who expressed interest in participating were supported by agency personnel to contact the researchers at a toll-free number and were offered the option of completing the survey through an in-person interview at a safe location. Consent from these 49 participants was obtained in writing following careful review of the study procedures, risks and safeguards.

Interviewers completed a detailed training program that included general interviewing skills, administration of the survey protocol, talking to men about abuse, mandatory abuse reporting requirements and procedures for handling abuse disclosure, and strategies for interviewing persons with cognitive disabilities. Interviewers were provided with a comprehensive written training manual and participated in role-play survey administration practice sessions.

Telephone participant's survey responses were directly entered into an electronic file by the interviewers. Surveys conducted through in-person interviews were sent to the SRL for entry into the electronic file.

Mandatory abuse reporting. The computer software was programmed to notify interviewers at the conclusion of each interview if a man's answer(s) would trigger mandatory abuse reporting in his state. Abuse reports were made for 42% of men (n = 104), ranging from 12% of participants in Oregon, where reporting is required only for men who receive publicly-funded developmental disabilities or mental health services, to 68% in California, where abuse reporting is mandatory for all dependent adults. Men were notified of the need to make a report and invited to participate, if they desired. Individual abuse reporting arrangements were made with the adult protective services agencies in each state and/or county; typically telephone reports were immediately made when men wished to participate. When a man did not wish to participate, a telephone abuse report was made followed by a faxed written report.

A standardized reporting form was created that listed the forms of reportable abuse included in the survey, with check boxes to indicate which forms had been disclosed during the interview. Interviewers were instructed not to deviate from the survey questions. The only additional abuse data that was obtained occurred when men volunteered additional information for reporting purposes. Challenges to protecting men's confidentiality as research participants while addressing the abuse reporting requirements were very complex. Participants expressed frustration about having their responses to a survey reported to APS, while APS representatives expressed frustration that the researchers did not ask follow-up questions to obtain additional information for APS reports.

Survey instrument. The survey had 5 major sections. The first section included a series of demographic questions, including age, gender, marital status, education, employment, disability type and severity, types of PAS used, relationship of PAS provider, and whether the provider was paid or unpaid. The second section listed 25 abusive behaviors of PAS providers, integrating some of the previous questions on the women's survey (Powers et al., 2002) with information from our men's focus group study (Saxton et al., 2006). Examples of these behaviors (Table 1) include "yells or screams; damages or keeps from using equipment such as a wheelchair, cane, walker, or telephone; forges checks, uses credit/debit card or personal identity without permission; touches sexually or forces sexual activity in unwanted ways; refuses to give medication, keeps from taking it, or gives too much or too little; hits, kicks, slaps, or otherwise physically hurts; and demands things, such as money, drugs, or alcohol in exchange for care."

Participants were first asked to rate each behavior on a 4-point scale (range 0-3) how much hurt each behavior would cause for someone with a similar disability (0 = not hurtful; 1 = a little; 2 = quite a bit; 3 = a lot). The standardized item alpha for men's hurtfulness rating was .96. Participants were then asked if they had ever experienced any of the behaviors in their lifetime, and if yes, whether they had experienced it within the last year.

Participants who endorsed any individual abuse behavior were asked if any of these experiences had kept men from doing their jobs, being as healthy as possible, and living independently. They were also asked if a health or social service provider had ever questioned them about abuse.

Because mistreatment by disability services agencies was a predominate theme in our qualitative study (Saxton et al., 2006), four additional items were included that related to the mistreatment of men with disabilities by agencies (i.e., "agencies limit a man's ability or authority to manage his own care, agencies are set up with too many rules and regulations, individuals in agencies don't listen, take things seriously or return phone calls, agencies lack knowledge about the real needs of men with disabilities"). First, the men were asked to indicate whether they had ever experienced any of these behaviors, and if yes, within the past year. If they endorsed an item, they were asked how hurtful it had been using the same 0-3 scaling just described. The standardized item alpha for the agency behavior hurtfulness ratings was .77.

The third section of the survey asked men to rate on a 4-point scale (range 0 to 3) the extent to which 22 different factors, identified through the qualitative study, were barriers or obstacles to the prevention of PAS abuse (0 = not a barrier; 1 = a small barrier; 2 = a medium barrier; 3 = a big barrier). Factors (See Table 4) included "shortage of qualified personal assistance providers; lack of emergency, back-up personal assistance; men aren't supposed to tell (squeal) on others; person giving personal assistance is a family member; too uncomfortable to talk about abuse; nothing can be done about abuse; don't know whom to call; abuse services are not set up for men; lack of knowledge or experience about how to recruit, train or supervise personal assistance providers; and fear of backlash from the personal assistance provider." The standardized item alpha for the barriers was .94.

The fourth section of the survey asked men to rate on a 4-point scale (range 0 - 3) the helpfulness of 30 strategies (See Table 5), identified through the qualitative study, to stop or prevent PAS abuse (0 = not helpful; 1 = sort of helpful; 2 = quite helpful; 3 = very helpful). Strategies included "setting limits about what treatment is and isn't appropriate; being able to choose who provides personal assistance services; training for men with disabilities in how to choose and supervise personal assistants; being asked about abuse by a doctor, nurse, case manager or other professional; having a back-up care provider lined up; educate the public that men with disabilities experience abuse; have information about abuse (e.g. what's abusive, where to report, resources in community); avoid abuse by keeping to yourself; calling the police; and reminding yourself not to put up with abuse or mistreatment." The standardized item alpha for the strategies was .86.

At the end of the survey, men were asked to indicate which people (i.e., doctors, nurses, case manager, independent living center staff, counselor, religious person) men would feel comfortable asking them about abuse. The final questions were slightly modified versions of the abuse screening questions most commonly used for all women, which were also asked in the women with disabilities survey (Powers et al., 2002). The men were asked if they had ever or in the past year been: "hit, slapped, kicked or otherwise physically hurt by anyone?" or "touched in a way you did not want to be touched or forced into sexual activity you did not want?"

Results

ANOVA was used to detect differences in participant demographic characteristics across states. Although significant differences were found, their effect sizes were very small suggesting it would be appropriate to combine the data across states. Ethnicity data was collapsed into Caucasian and ethnic/racial minority categories due to the small cell sizes for individual ethnic/racial groups. Provider payment arrangement (paid, unpaid) for personal care was selected for follow-up analysis because personal care was utilized by 73% of the participants and it is a form of PAS that can include intimate contact between provider and user. To accommodate the multiple comparisons performed and to highlight effect sizes with a meaningful magnitude, findings with p-values at .01 or less and relative risk ratios (RR) of at least 1.5 are reported.

Characteristics of Participants

The 342 participants ranged in age from 18 to 73, with a mean age of 47 years. Most men (n = 212) lived in Oregon, 73 lived in Washington and 57 lived in the San Francisco Bay Area. The majority of participants (79%) were Caucasian; (6%) were of Hispanic descent. With regard to men's race, 23 were African American, 10 were Asian, 10 were Native American and 2 were Native Hawaiian/Pacific Islander. Twenty-two men indicated they were of more than one race or another race. Three men did not disclose their race or ethnicity. With regard to education status, 32% had completed grade school or high school, 40% had attended some college, and 28% had completed a college degree. Twenty percent of the men were employed in paid jobs, 12% performed volunteer work, 5% were students, and 63% were not engaged in work or school. Thirty-nine percent of the men were single, 38% were married or living with a partner, 18% were separated or divorced, and 1% were widowed.

Participants reported a range of disabilities, with many reporting more than one type of disability. Mobility disability was the most common (83%). Seventeen percent of the men self-identified as having cognitive disability and/or receiving developmental disabilities services for persons with cognitive disability. Visual disability was reported by 14%, mental health disability by 9%, speech disability by 7.3%, learning disability by 7% and hearing disability by 2%. The majority of men (57%) acquired their disability after the age of 21, followed by (23%) who developed their disability during childhood and 20% who were born with their disability. Most men reported their disabilities as severe (57%), with 33% reporting moderate disability and 9% reporting mild severity of disability. Forty-seven men reported they used a ventilator, 185 indicated they used a power wheel chair, and 49 men used augmentative communication devices.

All participants confirmed they used some form of personal assistance at least three times per week. The majority, 73% of men, received some type of personal care (e.g., assistance with activities such as dressing, bathing, and eating). Of these men, 49% received personal care from a family member, 10% received care from a friend and 40% received care from someone else. Most men (59%) had paid personal care providers, whereas 41% used unpaid providers. The majority of providers (77%) were female. In addition to personal care, most men (85%) used homemaking services, the majority of which was provided by a family member or friend (66%). Half of the men paid for the homemaking services while half did not. Other forms of assistance used by men included transportation (n = 243), managing appointments and finances (n = 181) and help at work or school (n = 75).

Incidence of Abuse

Our first research question examined participant's lifetime and past year experience of physical and sexual abuse by any perpetrator and their experience of PAS abuse.

Abuse by any perpetrator. Participant's response to standard screening questions asking about lifetime incidence of physical and sexual abuse by anyone indicated that 65% of the men experienced physical abuse; 55% of these men had experienced physical abuse since acquiring their disability. Twenty-four percent of participants indicated they had been forced into unwanted sexual activity at some time during their lives; 52% of these men indicated they had been sexually abused since acquiring their disability. This rate of lifetime physical abuse is similar to that reported by women with disabilities and men without disabilities (Powers et al., 2002; Tjaden & Thoennes, 2000). The rate of lifetime sexual abuse reported by these men with disabilities is similar to women without disabilities in the United States (National Research Council, 1996); about half the rate reported by women with disabilities (Powers et al., 2002), and approximately eight times those reported by men without disabilities (Tjaden & Thoennes, 2000).

Participants reported an 8.5% rate of past year physical abuse by anyone and a 2.5% rate of past year sexual abuse by anyone. This is higher than the 3% combined rate of past year physical and sexual abuse by an intimate partner reported by men without disabilities (Tjaden & Thoennes, 2000).

Overall PAS abuse. Table 1 presents the percentage of men who reported experiencing each form of PAS abuse behavior across their lifetime, and of these men, the percentage who reported the abuse had occurred in the past year. The most commonly reported behaviors (at least 20% of men affected) included examples of poor job performance, verbal abuse, restricting or controlling life, rough handling, violating privacy, and financial abuse. Approximately 12% of the participants reported physical abuse, 18% reported this occurring in the past year. About 12% of participants reported manipulation of their medications, 66% reported this occurring in the past year. Being pressured for sex by their PAS provider was reported by 11%, with 37% of these men reporting this occurred in the past year. Approximately, 9% percent of participants indicated they had been touched sexually in unwanted ways by their PAS provider, with 31% of these men indicating this abuse happened in the past year. Thus, comparing participant's answers to standard physical and sexual abuse screening questions for abuse by anyone vs. abuse by PAS providers, 11% of men reported PAS provider physical abuse vs. 65% of men reporting physical abuse by anyone; and 9% of men reported PAS provider sexual abuse vs. 24% of men reporting sexual abuse by anyone. An average of 22% of participants reported lifetime exposure to any one type of PAS abuse, with 53% percent of these men indicating the abuse had occurred in the past year.

Differential PAS abuse. In comparison to men who did not have cognitive disabilities, men with cognitive disabilities were (a) over two times more likely to report a lifetime incidence of providers refusing to give medication or giving too much or to little ([c.sup.2] = 6.76, p = .009, RR = 2.31); (b) nearly three times more likely to report being held against their will or restrained ([c.sup.2] = 7.27, p = .007, RR = 2.86); and (c) two and a half times more likely to report being hit, kicked, slapped or otherwise hurt ([c.sup.2] = 8.99, p = .003, RR = 2.54). Likewise, participants who were born with a disability were nearly three times more likely to report their provider refused to give medication or gave them too much or too little ([c.sup.2] = 12.692, p = .000, RR = 2.87); and over three times more likely to have been hit, kicked, slapped or otherwise physically hurt than men who acquired their disability after birth ([c.sup.2] = 15.813, p = .000, RR = 3.14).

In comparison to married or partnered men, those who were single, divorced or widowed reported an increased incidence of abuse on several behaviors. They were over ten times more likely to report their provider demanded things, such as money, drugs and alcohol, in exchange for care ([c.sup.2] = 17.479, p = .000, RR = 10.2), and they were over four times more likely to report being hit, kicked, slapped or otherwise hurt ([c.sup.2] = 12.15, p = .000, RR = 4.23). Single, divorced or widowed men were nearly four times more likely to report their provider was drunk or high while providing care ([c.sup.2] = 22.827, p = .000, RR = 3.83), and over three times more likely to report their provider expected or pressured them to respond to sexual advances ([c.sup.2] = 8.397, p = .004, RR = 3.17). They were nearly three times more likely to report their PAS provider (a) intentionally left them in a dangerous situation ([c.sup.2] = 8.698, p = .003, RR = 2.8); (b) stole money, valuables, or equipment ([c.sup.2] = 18.658, p = .000, RR = 2.79); and (c) forged checks, or used their credit/debit or personal identity without permission ([c.sup.2] = 8.119, p = .004, RR = 2.72). Finally, single, divorced or widowed men were over two times more likely to report their care provider had threatened to hurt them, withhold care, or leave them unattended ([c.sup.2] = 7.149, p = .008, RR = 2.26).

Having a paid PAS provider also was associated with increased incidence of several abusive behaviors. In comparison to respondents with unpaid PAS providers, those with paid providers were nearly six times more likely to report being intentionally left in a dangerous situation ([c.sup.2] = 16.9, p = .000, RR = 5.82), and nearly three times more likely to report their PAS provider was drunk or high while providing care ([c.sup.2] =15.273, p = .000, RR = 2.84). Participants with paid providers were over two times more likely to report their provider: (a) neglected or ignored their physical needs ([c.sup.2] = 7.299, p = .007, RR = 2.3); (b) left early, came late or did not show up ([c.sup.2] = 24.358, p = .000, RR = 2.2); (c) threatened to hurt, withheld care, or left them unattended ([c.sup.2] = 6.117, p = .013, RR = 2.13); (d) handled them roughly during care ([c.sup.2] = 9.604, p = .002, RR = 2.11); and (e) stole money, valuables, or equipment ([c.sup.2] = 9.958, p = .002, RR = 2.08).

Compared to participants with family PAS providers, men with non-family PAS providers (including friends) were over three times as likely to report being intentionally left in a dangerous situation ([c.sup.2] = 12.266, p = .000, RR = 3.2), and being hit, kicked, slapped, or otherwise physically hurt ([c.sup.2] = 10.127, p = .001, RR = 3.13). Participants with non-family providers were over two times as likely to report that their PAS provider: (a) stole medication ([c.sup.2] = 7.438, p = .006, RR = 2.12); (b) handled them roughly during care ([c.sup.2] = 10.823, p = .001, RR = 2.08); (c) stole money, valuables, or equipment ([c.sup.2] = 17.003, p = .000, RR 2.5 l); (d) forged checks, used credit/debit cards without permission ([c.sup.2] = 9.318, p = .002, RR = 2.84); (e) was drunk or high while providing care ([c.sup.2] = 7.874, p = .005, RR = 2.74); and (f) threatened to hurt, withhold care, or leave them unattended ([c.sup.2] = 11.091, p = .001, RR = 2.67). Respondents with non-family PAS providers also were significantly more likely to report their provider leaves early, comes late or does not show up at all, however it is unclear whether or not family members who provide care would be expected to adhere to regularly scheduled hours.

Surprisingly, men with male PAS providers were no more likely to report abuse than men with female PAS providers. When asked if they had been hit, slapped, kicked, or otherwise physically hurt by anyone in the past year, a Chi-square analysis detected a weak association between male gender of PAS provider and increased abuse ([c.sup.2] = 3.492, p = .062). Significant associations were not found for provider gender and any other abuse behaviors. This finding contradicts findings by Oktay and Tompkins (2004), which found that individuals with male providers experienced a significantly higher rate of abuse than individuals with female providers.

Hurtful PAS Behaviors

Table 2 lists the percentage of participants that endorsed each level of hurtfulness for the PAS provider behaviors. As expected, the responses were positively skewed with the majority of men responding that items were either "quite" or "a lot" hurtful. These behaviors clustered into categories that include (a) physical, sexual, verbal and financial abuse or threat of abuse, (b) neglect, (c) withholding or destruction of equipment, (d) inappropriate administration of medications, (e) providing PAS while intoxicated, and (f) inappropriate exertion of physical or verbal control (e.g., discounts or ignores requests, or demands things, such as money, drugs or alcohol in exchange for care). The five most frequent behaviors identified as most hurtful (endorsed as either quite or a lot by over 90% of participants) were: 1) steals money, valuables or equipment; 2) forges checks or credit cards; 3) hits kicks slaps or otherwise physically hurts; 4) threatens to hurt, withhold care or leave unattended; and 5) to be left intentionally in a dangerous situation.

Chi-square was used to detect the influence of demographic factors on hurtful ratings. Significant associations (p <.01; RR >1.5) were not found between hurtful ratings and marital status, disability type, age of disability onset, ethnicity, whether the PAS provider was paid or unpaid, or gender of provider.

Examination of the impact of PAS abuse on participant's engagement in life activities revealed that 18.6% of the men reported that the abuse impeded their obtaining or maintaining employment; 31.1% indicated that the abuse impeded taking care of their health; and 21.1% reported that the abuse impeded their living independently.

Mistreatment by disability service agencies. Table 3 shows men's reported lifetime and past year incidence of mistreatment by disability service agencies and the percentage of those indicating the level of hurt for each type of abuse. In general, participants indicated that mistreatment by disability service agencies was a little to quite hurtful and their lifetime incidence of exposure ranged from 25% to 47%. As noted with PAS provider hurtful ratings, hurtful ratings for disability service agencies also were negatively skewed with the majority of men (>80% of sample) reporting the following to be either quite or a lot hurtful: (a) service agencies that limit a man's ability or authority to control or manage his own care (86.3%), (b) service agencies that don't listen, take things seriously, or return phone calls (86.2%), and (c) service agencies that lack knowledge about the real needs of men with disabilities (84%).

Men with paid providers were nearly twice as likely to report that agencies limited their abilities or authority to manage their care ([c.sup.2] = 7.032, p = .008, RR = 1.85). Men with non family providers also were nearly twice as likely to report this type of abuse than men with family providers ([c.sup.2] = 7.49, p = .006, RR = 1.82). Significant differences in incidence or hurtfulness ratings were not found for disability type, age of disability onset, marital status, or ethnicity.

Barriers that Impede Men's Handling of Abuse

Our third research question focused on identifying the most critical barriers that impede men's handling of personal assistance abuse. As shown in Table 4, barriers identified as the largest (endorsed as medium or big by more than 75% of men) included: low provider wages and benefits; reporting abuse may lead to loosing independence; shortage of qualified providers; lack of knowledge about recruiting and training providers; provider burnout; and people don't believe men can be abused.

Chi-square was used to examine the influence of demographic factors on importance ratings for PAS management barriers. Percentages obtained for medium and big barriers were collapsed as were percentages obtained for not a barrier or small barrier. The data was collapsed because of skewness and because we thought a collapsed data comparison would yield the clearest interpretation of the influence of demographic factors. There were no significant differences in barrier ratings as a function of age of disability onset, ethnicity, marital status, or provider gender, payment or relationship. The only significant difference was men with cognitive disabilities, compared to men with other disabilities, rated having personal assistance provided by a friend as a significantly larger barrier ([c.sup.2] = 7.578; p = .006, RR = 1.59).

Abuse Response Strategies

Our final research question investigated men's perceptions of the most helpful strategies that they and others could use to prevent and/or stop personal assistance abuse. As shown in Table 5, the top three PAS management strategies that men rated as quite or very helpful were being able to choose who provides personal assistance services; having backup emergency care providers lined up; and having access to emergency transportation. The most highly endorsed personal strategies were reminding oneself not to put up with abuse and dealing with problems in the PA relationship before they get out of control. Additional resources men endorsed as most helpful included having information about abuse; being asked about abuse by a professional; having someone to help sort out abuse; assistance finding abuse resources; setting-up abuse resources for men; training for men in choosing and supervising personal assistants; assistance in screening personal assistants; and training for the personal assistant in abuse.

For the same reasons noted for collapsing the barrier data, percentages obtained for not or sort of helpful strategies were collapsed as were percentages obtained for quite or very helpful strategies. Compared to participants with other disabilities, men with cognitive disabilities were three and a half times more likely to endorse "avoid abuse by keeping to yourself" ([c.sup.2] = 24.541, p = .000, RR = 3.47) as quite or very helpful; and nearly 3 times more likely to report "give assistant what they want so you get what you need" as quite or very helpful ([c.sup.2] = 26.419, p = 000, RR = 2.75). Men who had female PAS providers were nearly twice as likely to report "limit contact with personal assistant to only what's needed" as a quite or very helpful strategy compared to men with male providers ([c.sup.2] = 12.572, p = .000, RR = 1.85). Significant differences were not found for men's ethnicity, provider payment or relationship, age of disability onset or marital status.

When queried about whether they had ever been asked about abuse by a health or social service provider, 22.5% of participants indicated they had been asked about abuse, 76.3% reported they had not been asked about abuse, and 1.2% indicated that they didn't know or refused to answer. These rates are similar to those reported by women with disabilities (Powers et al., 2002). Men with paid providers were about two and one half times more likely to report they had been asked about abuse than men with unpaid providers ([c.sup.2] = 12.640, p = .000, RR = 2.45). Men with cognitive disabilities were almost twice as likely to report they had been asked about abuse compared to men with other types of disabilities ([c.sup.2] = 7.151, p = .007, RR = 1.84). Men with personal care providers who were not family members were twice as likely to report they had been asked about abuse ([c.sup.2] = 8.215, p = .004, RR = 2.17).

Participants reported the following preferences for the person who should perform abuse screening: (a) 68.7% by a doctor; (b) 54.4% by a counselor; (c) 48.5% by a religious person; (d) 47.4% by a case manager; (e) 35.4% by a therapist; (f) 35.1% by an independent living staff person; and (g) 19.3% by a nurse.

Discussion

The findings suggest that men with physical disabilities, and physical and cognitive disabilities combined, experience lifetime physical abuse by any perpetrator at rates comparable to women and men without disabilities, and their reported lifetime incidence of sexual abuse is similar to women without disabilities and dramatically higher than men without disabilities. Men with disabilities reported about the same lifetime level of physical abuse and about half the incidence of sexual abuse as women with disabilities in our previous study (Powers et al., 2002). Participants reported a higher incidence of past year physical and sexual abuse by anyone compared to men without disabilities reporting past year intimate partner violence (Tjaden & Yhoennes, 2000).

Although men's incidence of PAS abuse may be lower than that of women with disabilities, it is nonetheless disturbing, particularly given that virtually no attention has been focused on this problem. Abuse by personal assistants takes many forms and poses significant obstacles to men's capacities to live independently, care for their health, and work. Forms of PAS abuse include physical, sexual, verbal and financial abuse, threat of physical abuse, neglect, withholding or destruction of equipment, inappropriate administration of medications, providing PAS while intoxicated, and inappropriate exertion of physical or verbal control. Men also reported experiencing various types and levels of mistreatment by disability service agencies. Forty-seven percent of men reported that they had experienced individuals in agencies that don't listen, take things seriously or return phone calls - support that is essential if undisclosed abuse is to be recognized and validated.

An increased exposure to disability service agencies may have been one reason why men with paid providers, cognitive disabilities and non-family providers were more likely to report having been screened for abuse by a health or social service provider. The majority of participants said they would prefer to be screened by a physician, while a small percentage indicated they would like to be screened by a nurse, perhaps indicating their comfort with talking to someone who they perceive as likely to be male. The finding that 49% preferred to be screened by a religious person may suggest a need for privacy and personal attention.

Men validated the importance of barriers to PAS abuse management previously identified through our qualitative study of men's experiences (Saxton et al., 2006). The respondents emphasized barriers related to poor PAS provider wages and benefits and provider shortages; societal beliefs that men are not abused; lack of abuse recognition, screening or services for men; concern that acknowledging PAS abuse will result in loss of independence and institutionalization; lack of knowledge among men related to recruiting and training PAS providers; and personal discomfort.

The majority of strategies identified by men to address these barriers will require systemic changes that will enable men with disabilities access to qualified and adequately compensated PAS providers, back-up providers, transportation, and information about abuse. It is clear that men with disabilities want their experiences to be more clearly understood and more effectively addressed than the current reality.

Some differences in men's experiences and perceptions were associated with demographic factors, primarily type of disability, relationship to PAS provider and provider payment arrangement. For example, men with cognitive disabilities reported a significantly higher incidence of lifetime sexual abuse by anyone, and of PAS providers manipulating their medications, restraining them, and hitting, kicking, slapping or otherwise hurting them. Generally, men with cognitive and physical disabilities endorsed similar barriers and strategies to addressing abuse as did men with just physical disabilities. However, the men with cognitive disabilities reported keeping the abuse to yourself and giving the personal assistant what they need to get what you want as more important strategies than men with just physical disabilities. These findings suggest than men with cognitive disabilities may be more likely to believe it is preferable to handle abuse on their own, which may relate to our previous findings that these men often have their credibility doubted and fear negative repercussions, such as institutionalization, if they report abuse (Saxton, et al., 2006).

The most striking finding from this study is the increased incidence of many forms of PAS abuse among men who are not married or partnered, who have non-family providers and who have paid providers. Men also rated receiving PAS from family members and friends as the least important barriers to addressing abuse. Taken together, these findings suggest that men who receive PAS from family members, most of whom are not paid, are to some extent protected from experiencing PAS abuse. This interpretation is consistent with studies of person-directed services, which indicate that when individuals have a choice of provider, they often choose family members and they report higher levels of safety (Foster, Brown, Phillips, Schore, & Carlson, 2003; Benjamin et al., 1998). However, these findings do not negate the very real problem that many individuals with disabilities report when they have to manage serious trade-offs or escape from an abusive relationship with a family member.

Several limitations require caution when interpreting these findings. The most significant is the unrepresentative sample. While our use of DME providers increased the percentage of participants who used informal PAS compared to our women's study (Powers, et al, 2002), the men were selectively invited to participate and a fairly small proportion of those men invited to participate elected to do so. It is possible that the men who chose to participate were more likely to have had abuse experiences than non-participants, and their identification of barriers and strategies may have been influenced by their experiences with PAS providers and systems. In an effort to preliminarily explore relationships between the abuse experienced by men and women with disabilities, we compared the findings from this study to our past study of women PAS users with similar disabilities (Powers et al., 2002). However, neither study used a population-based sample and the sampling techniques were intentionally different.

Another limitation of the study concerns the accuracy of men's self-reports. The study asked men to report their abuse experiences and it is possible that their recollections were not accurate. However, literature on the accuracy of self-reporting indicates that when respondents clearly understand what information is being requested, have access to the information, and are willing to respond, the accuracy of self-report increases (Armstrong, Jensen, McCaffrey, & Reynolds, 1976; Laing, 1988), and can be as good or even better than other evaluation techniques.

Given these limitations, this study suggests that abuse against men with disabilities is a serious problem that requires attention. The findings highlight a need for additional research in a number of areas. As Powers et al., stated in 2002, it is unacceptable that we do not have accurate population-based data on the prevalence of abuse against women and men with disabilities, given the disturbing finding from extant research using purposeful samples. Our findings also highlight the need to clarify what appears to be a complex relationship between PAS abuse, non-family providers and payment. Understanding this area would be helpful for both addressing abuse and for establishing PAS services that most effectively serve individual's needs. Research is also needed to further understand how preconceptions about masculinity impact men's identification and response to abuse, men's management of trade-offs in their relationships and the impact on their safety, and other strategies than men use to increase their resilience in dealing with abuse. Most importantly, we must discover and validate gender-appropriate methods to support men in recognizing and validating abuse as well as methods for designing and outreaching responsive abuse services. Increasing our understanding in these areas will most likely benefit both men and women with disabilities.

Important solutions include providing increased opportunity for men to choose and manage their PAS providers and to access expanded abuse supports. However, the most critical first step for achieving these goals may be education of the public and professionals about the problem of abuse for men with disabilities so that momentum can be built for addressing these barriers and responding to their needs. Additionally, the findings provide some helpful clues about support strategies that may be most helpful for supporting men, including increasing the capacities of religious leaders, counselors and doctors to talk with men about abuse; providing men with disabilities and personal assistants with training in abuse and PAS management; allowing men increased control over their personal assistance services; and increasing men's access to abuse services. Perhaps new hope, confidence and possibilities will be revealed as we end the silence.

Acknowledgment

This study is dedicated to Jack Benson, who worked tirelessly to give voice to the problem of abuse against men with disabilities. The authors also express their gratitude to Mitch Tepper and Mark Limont for their invaluable consultation to this study. We thank Dr. Debi Elliott and the staff of the Portland State University Survey Research Laboratory for managing the many challenges in data collection.

Preparation of this manuscript was supported, in part, by grant #H133G010040 from the National Institute on Disability and Rehabilitation Research, US Department of Education. Endorsement of the opinions expressed herein by the funding agency should not be inferred.

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Laurie E. Powers

Portland State University

California

Mary Ann Curry

Oregon Health & Science University

Elizabeth McNeff

Portland State University

Marsha Saxton

World Institute on Disability, Oakland,

Jennifer L. Powers

Portland State University

Mary Oschwald

Portland State University

Laurie Powers, Ph.D., Regional Research Institute, Portland State University, PO Box 751, Portland, Oregon 97207. Email: powersl@pdx.edu
Table 1.
Percentage of participants who reported PAS abuse lifetime and past
year.

                                                 Abuse Frequency

                                                            Past
Behavior                                   Lifetime    N    year    N

Takes over by doing things the way he
  or she wants                               51.2     173   75.6   130
Makes remarks that insult or put down        46.7     158   61.0    97
Discounts or ignores requests                38.8     131   71.5    93
Leaves early, comes late or doesn't
  show up                                    38.4     129   66.7    86
Yells and screams                            35.0     118   59.5    69
Talks to others about personal
 information without permission              30.5     101   63.0    63
Pries into personal life, such as
  asking too many personal questions         28.0      94   60.6    57
Steals money, valuables, or equipment        24.6      82   48.2    40
Handles roughly during care, such as
  bathing, transfers, dressing &
  toileting                                  22.5      75   61.3    46
Gets into private belongings
  (mail, closets, files)                     22.2      74   59.5    44
Drunk or high while providing care           21.4      71   43.5    30
Denies or restricts choices, such as
  what to eat or when to go to bed           20.9      70   67.1    47
Withholds information important to
  well being, such as need for
  medication refill)                         17.6      59   57.6    34

                                                 Abuse Frequency

                                                            Past
Behavior                                   Lifetime    N    year    N

Steals medication                            16.4      55   58.2    32
Neglects/ignores physical needs              15.9      53   50.9    27
Threatens to hurt, withhold care or
  leave a man unattended                     15.3      51   38.0    19
Intentionally leaves in a dangerous
  situation, such as alone in bed for
  days                                       13.1      44   51.1    23
Forges checks, uses credit/debit card
  or personal identity without
  permission                                 12.9      43   34.1    15
Hits, kicks, slaps, or otherwise
  physically hurts                           11.7      39   18.4     7
Refuses to give medication, keeps from
  taking it, or gives too much or too
  little                                     11.6      39   65.8    25
Pressures to respond to sexual advances      11.1      37   36.8    14
Holds against will or restrains              10.5      35   34.3    12
Demands things, such as money, drugs,
  or alcohol in exchange for care            10.4      35   65.7    23
Damages or keeps man from using
  equipment such as a wheelchair,
  cane, or telephone line                    10.4      35   38.2    13
Touches sexually or forces sexual
  activity in unwanted ways                   9.3      31   31.3    10

Table 2.
Percentage of participants who reported PAS behaviors as not hurtful,
a little hurtful, quite hurtful, and a lot hurtful.

                                                      Not     A little
Behavior                                       N    Hurtful   Hurtful

Steals money, valuables or equipment          335      5.4       3.0
Forges checks/credit cards                    337      6.2       2.4
Hits, kicks, slaps or otherwise physically
  hurts                                       336      6.0       3.3
Threatens to hurt, withhold care or leave
  unattended                                  336      6.3       3.3
Intentionally left in dangerous situation     337      6.8       3.0
Neglects or ignores physical needs            334      6.0       4.2
Damages or keeps from using equipment         337      6.8       3.9
Holds against will or restrains               334      8.1       3.6
Steals medication                             332      8.4       6.3
Touches sexually in unwanted ways             333      8.1       6.9
Drunk or high on job                          336      7.7       8.0
Refuses meds, gives too much                  336     11.3       6.0
Demands things, such as money, drugs or
  alcohol in exchange for care                335      8.7       8.7
Handles roughly                               335      7.2      11.3
Talks to others about personal information    334      8.1      11.4
Gets into private belongings                  337      6.2      14.5
Withholds important information               334     10.5      10.5
Leaves early, comes late                      337      6.8      15.1
Discounts or ignores requests                 336      7.4      16.1
Pressures to respond to sexual advances       332     10.8      13.6
Restricts choices                             335      6.9      18.2
Yells or screams                              337     14.0      16.9
Takes over                                    336     11.0      27.7
Insults or puts down                          339     14.7      26.0
Pries into personal life                      337     10.4      33.5

                                                    Quite     A lot
Behavior                                           Hurtful   Hurtful

Steals money, valuables or equipment                18.5       73.1
Forges checks/credit cards                          13.4       78.0
Hits, kicks, slaps or otherwise physically
  hurts                                             10.1       80.7
Threatens to hurt, withhold care or leave
  unattended                                        21.1       69.3
Intentionally left in dangerous situation           10.7       79.5
Neglects or ignores physical needs                  21.3       68.6
Damages or keeps from using equipment               23.7       65.6
Holds against will or restrains                     16.2       72.2
Steals medication                                   16.9       68.4
Touches sexually in unwanted ways                   16.8       68.2
Drunk or high on job                                19.9       64.3
Refuses meds, gives too much                        15.5       67.3
Demands things, such as money, drugs or
  alcohol in exchange for care                      20.6       62.1
Handles roughly                                     29.0       52.5
Talks to others about personal information          28.7       51.8
Gets into private belongings                        31.8       47.5
Withholds important information                     26.3       52.7
Leaves early, comes late                            37.4       40.7
Discounts or ignores requests                       34.5       42.0
Pressures to respond to sexual advances             21.4       54.2
Restricts choices                                   34.9       40.0
Yells or screams                                    26.1       43.0
Takes over                                          33.0       28.3
Insults or puts down                                29.8       29.5
Pries into personal life                            29.4       26.7

Table 3.
Percentage of participants who report behavior by disability
service agencies life time and past year; and percentage who
reported behavior as not hurtful, a little hurtful, quite hurtful,
and a lot hurtful.

                                             Abuse Frequency

Behavior                          Lifetime     N     Past Year     N

Individuals in agencies don't
listen, take things seriously
or return phone calls               48.5      161      66.0       105

Agencies are set up with too
many rules and regulations          44.8      148      59.2       87

Agencies lack knowledge about
the real needs of men with
disabilities                        42.8      142      62.0       88

Agencies limit a man's ability
or authority to manage his
own care                            26.0       86      75.6       130

                                            Hurtful Rating

Behavior                          Not    A little   Quite   A lot   N

Individuals in agencies don't
listen, take things seriously
or return phone calls             3.0      10.8     30.6    44.4   333

Agencies are set up with too
many rules and regulations        5.2      19.8     34.3    40.7   329

Agencies lack knowledge about
the real needs of men with
disabilities                      30.0     13.0     32.8    51.2   332

Agencies limit a man's ability
or authority to manage his
own care                          2.7      11.0     30.8    55.5   328

Table 4.
Percentage of participants who reported factor as not a barrier,
a small barrier, a medium barrier, and a big barrier to preventing
or stopping PAS abuse.

                Barrier                               Not a     Small
                                                N    Barrier   Barrier

Low wages and benefits for personal
  assistants                                   331     10.0      10.0
Reporting the abuse may lead to loosing
  independence, like going to a nursing
  home or institution                          324     13.0      7.4
Shortage of personal assistants                328     11.3      11.9
Lack of knowledge or experience about how
  to recruit and train personal assistants     322     10.2      12.4
PAS provider burn out                          322     9.3       14.6
People don't believe that men can be abused    331     13.0      11.5
Abuse services are not set up for men          320     12.8      15.0
Disability service providers don't check
  for or help with abuse                       326     14.7      12.9
Ending the abuse may mean giving up
  something of value like being with
  family or having a good time                 325     15.4      13.2
Lack of emergency, back-up personal
  assistance                                   328     15.5      13.1
Too uncomfortable to talk about the abuse      332     13.0      16.3
Lack of control over choosing, paying,
  managing or firing provider                  332     16.6      13.0
Don't know who to call                         333     16.5      13.2
Would not be believed if reported abuse        331     16.0      14.5
Backlash from personal assistant               326     17.5      13.5
Nothing can be done about abuse                328     20.7      11.3
Personal assistants are not sure about
  what's expected of them                      330     13.9      20.3
If men are abused, others think it's
  because others think they made
  poor choices                                 328     17.1      18.0
It's not okay for men to complain about
  personal stuff like abuse                    335     19.4      17.0
Men aren't supposed to tell (squeal) on
  others                                       330     23.3      20.9
Personal assistant is a family member          329     28.0      19.8
Personal assistant is a friend                 323     37.2      25.7

                Barrier                             Medium     A lot
                                                    Barrier   Barrier

Low wages and benefits for personal
  assistants                                         23.3      56.8
Reporting the abuse may lead to loosing
  independence, like going to a nursing
  home or institution                                17.9      61.7
Shortage of personal assistants                      22.6      54.3
Lack of knowledge or experience about how
  to recruit and train personal assistants           33.5      43.8
PAS provider burn out                                28.3      47.8
People don't believe that men can be abused          23.6      52.0
Abuse services are not set up for men                28.4      43.8
Disability service providers don't check
  for or help with abuse                             27.0      45.4
Ending the abuse may mean giving up
  something of value like being with
  family or having a good time                       22.2      49.2
Lack of emergency, back-up personal
  assistance                                         21.3      50.0
Too uncomfortable to talk about the abuse            25.3      45.5
Lack of control over choosing, paying,
  managing or firing provider                        21.4      49.1
Don't know who to call                               19.8      50.5
Would not be believed if reported abuse              20.5      48.9
Backlash from personal assistant                     22.7      46.3
Nothing can be done about abuse                      17.7      50.3
Personal assistants are not sure about
  what's expected of them                            32.7      33.0
If men are abused, others think it's
  because others think they made
  poor choices                                       27.4      37.5
It's not okay for men to complain about
  personal stuff like abuse                          19.4      44.2
Men aren't supposed to tell (squeal) on
  others                                             21.8      33.9
Personal assistant is a family member                18.2      34.0
Personal assistant is a friend                       17.0      20.1

Table 5.
Percentage of men who reported strategies for preventing or stopping
PAS abuse as not helpful, sort of helpful, quite helpful, and
very helpful.

                                                       Not     Sort of
                  Strategy                      N    Helpful   Helpful

Low wages and benefits for personal
  assistants                                   331    10.0      10.0
Reporting the abuse may lead to loosing
  independence, like going to a nursing
  home or institution                          324    13.0       7.4
Shortage of personal assistants                328    11.3      11.9
Being able to choose who provides personal
  assistance services                          334     2.4       7.5
Have backup emergency care providers
  lined up                                     328     2.4       7.6
Access to emergency transportation to
  get help                                     333     2.7       8.1
Deal with problems in the relationship
  with the personal assistant before things
  get out of control                           328     3.7       8.2
Better working conditions for personal
  assistant (e.g. pay and benefits)            327     2.8       9.8
Access to information about a personal
  assistant such as criminal background
  checks or references                         330     3.3       9.4
Have information about abuse
  (e.g. what's abusive, where to report,
  resources in the community)                  334     3.6       9.6
Help from professionals to screen and
  train personal assistants                    331     3.9      10.3
Training for men with disabilities in how
  to choose and supervise personal
  assistants                                   327     2.1      12.2
Training for the personal assistant in
  ways to identify and deal with abuse         329     3.3      11.6
Be in charge of supervising the personal
  assistant                                    327     3.7      11.3
Set up services for men with disabilities
  experiencing abuse (e.g., crisis line,
  place to go in an emergency)                 330     3.6      11.5
Individuals in agencies that help men find
  abuse resources                              330     3.6      11.8
Someone who helps a man sort out abuse         327     2.8      13.1
Being asked about abuse by a professional      332     3.3      13.6
Remind yourself not to put up with abuse
  or mistreatment                              333     5.7      11.4
Set limits about what treatment is and
  isn't appropriate                            329     6.1      12.2
Educate public that men with disabilities
  experience abuse                             327     4.0      15.9
Be in charge of approving payments for
  personal assistant                           326     5.2      15.3
Do regular evaluations of the assistant's
  work                                         331     2.7      20.2
Call the police                                331     9.1      14.5
Access to discussion groups where men could
  talk about their experiences of abuse        327     8.0      17.7
Let personal assistant talk or vent            326     8.6      22.1
Have more than one personal assistant          323     9.3      21.7
Take steps to protect yourself, such as
  hiding medication or money so it can't
  be stolen                                    326    13.5      17.8
Religious or spiritual support                 326    14.7      23.6
Limit contact with personal assistant
  to only what's needed                        327    22.9      23.2
Give assistant what he/she wants so you
  get what you need                            322    54.0      21.7
Put up with some abuse in order to get
  what you need                                326    67.8      12.3
Avoid abuse by keeping to yourself             330    72.1      12.7

                                                   Quite     Very
                  Strategy                        Helpful   Helpful

Low wages and benefits for personal
  assistants                                       23.3      56.8
Reporting the abuse may lead to loosing
  independence, like going to a nursing
  home or institution                              17.9      61.7
Shortage of personal assistants                    22.6      54.3
Being able to choose who provides personal
  assistance services                              16.8      73.4
Have backup emergency care providers
  lined up                                         18.6      71.3
Access to emergency transportation to
  get help                                         20.1      69.1
Deal with problems in the relationship
  with the personal assistant before things
  get out of control                               19.8      68.3
Better working conditions for personal
  assistant (e.g. pay and benefits)                22.9      64.5
Access to information about a personal
  assistant such as criminal background
  checks or references                             12.4      74.8
Have information about abuse
  (e.g. what's abusive, where to report,
  resources in the community)                      22.5      64.4
Help from professionals to screen and
  train personal assistants                        20.2      65.6
Training for men with disabilities in how
  to choose and supervise personal
  assistants                                       25.1      60.6
Training for the personal assistant in
  ways to identify and deal with abuse             22.2      62.9
Be in charge of supervising the personal
  assistant                                        22.0      63.0
Set up services for men with disabilities
  experiencing abuse (e.g., crisis line,
  place to go in an emergency)                     23.0      61.8
Individuals in agencies that help men find
  abuse resources                                  22.7      61.8
Someone who helps a man sort out abuse             22.3      61.8
Being asked about abuse by a professional          26.8      56.3
Remind yourself not to put up with abuse
  or mistreatment                                  21.0      61.9
Set limits about what treatment is and
  isn't appropriate                                28.9      52.9
Educate public that men with disabilities
  experience abuse                                 19.3      60.9
Be in charge of approving payments for
  personal assistant                               23.6      55.8
Do regular evaluations of the assistant's
  work                                             27.2      49.8
Call the police                                    17.5      58.9
Access to discussion groups where men could
  talk about their experiences of abuse            22.9      51.4
Let personal assistant talk or vent                26.1      43.3
Have more than one personal assistant              20.7      48.3
Take steps to protect yourself, such as
  hiding medication or money so it can't
  be stolen                                        20.9      47.9
Religious or spiritual support                     22.4      39.3
Limit contact with personal assistant
  to only what's needed                            23.9      30.0
Give assistant what he/she wants so you
  get what you need                                 7.5      16.8
Put up with some abuse in order to get
  what you need                                     7.7      12.3
Avoid abuse by keeping to yourself                  5.2      10.0
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Article Details
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Author:Powers, Laurie E.; Curry, Mary Ann; McNeff, Elizabeth; Saxton, Marsha; Powers, Jennifer L.; Oschwald
Publication:The Journal of Rehabilitation
Article Type:Report
Geographic Code:1USA
Date:Oct 1, 2008
Words:11749
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