Sexual Assault and Persons with Disabilities

A Note to Service Providers

In the course of your work, you may encounter sexual assault victims who have a cognitive, sensory or mobility disability or a mental illness. Like any victim of sexual assault, people with disabilities who have experienced sexual violence may feel powerless, vulnerable and afraid. However, many factors can complicate their ability to disclose the assault to others, reach out for help and access services. To enhance the assistance you provide to them, build your knowledge related to fundamental issues in providing accessible and responsive services to sexual assault victims with disabilities. Consider what you and your agency can do to create a welcoming environment to serve persons with disabilities. Learn how to help victims with disabilities identify and address their post-assault needs, as well as ways to help reduce their risk of future victimization.

In addition, you and your agency can partner with other community agencies and systems to improve the accessibility and appropriateness of services across systems for sexual violence victims with disabilities.

For information on the above topics, see the WV S.A.F.E. Training and Collaboration Toolkit—Serving Sexual Violence Victims with Disabilities. In addition to the above topics, it provides tools to facilitate assessment and planning by individual agencies to improve the accessibility and appropriateness of their services for sexual violence victims with disabilities.

Terminology Used

Agencies that interact with sexual violence victims and persons with disabilities typically refer to the individuals they serve as "clients," "consumers" and/or "victims." For convenience, "victims" and "clients" are primarily used.

In recognition that the vast majority of victims of sexual violence are female and the vast majority of offenders are male¹, individual victims are often referred to using female pronouns and individual offenders are often referred to using male pronouns. This use of pronouns in no way implies that males are not victims of sexual violence or that females are not offenders; it is written solely for the ease of reading the material.

Prevalence

The 2000 U.S. Census indicated that West Virginia had the highest rate in the nation of civilian, non-institutionalized people age 5+ with a disability, at 24.4% of the population.
1 in 6 women and 1 in 21 men in West Virginia experienced sexual assault in their lifetimes.² These rates are significantly higher for residents who have a disability—14% for those with a disability compared to 9.6% for those without a disability.³
The risk of sexual victimization may be even higher for persons with specific types of disabilities, such as certain physical and cognitive disabilities, developmental disabilities and severe mental illnesses, as well as for those who have caregivers. As with the general population, more females with disabilities are sexually assaulted than males with disabilities. However, more males with disabilities are sexually assaulted than males without disabilities.
National studies indicate that only 14% to 39% of all sexual assaults are ever reported.⁴ Reporting by victims with a disability is even less frequent.

For more information on this topic, see B1. Sexual Victimization of Persons with Disabilities: Prevalence and Risk Factors in the WV S.A.F.E. Training and Collaboration Toolkit—Serving Sexual Violence Victims with Disabilities.

Risk Factors

Commonly cited risk factors for sexual victimization for persons with disabilities include:5

Type of disability
Gender
Negative public attitudes toward persons with disabilities that lead sex offenders to view them as easy targets and think it unlikely that their actions will result in a conviction
Social isolation
Communication barriers
Lack of accessible transportation
Reliance on others for care, assistance with personal needs and/or management of their affairs
Learned compliance of people with disabilities
Lack of knowledge about sexuality and/or healthy intimate relationships
Poverty
Lack of resources/knowledge of resources

For more information on the above topic, see B1. Sexual Victimization of Persons with Disabilities: Prevalence and Risk Factors in the WV S.A.F.E. Training and Collaboration Toolkit—Serving Sexual Violence Victims with Disabilities.

Barriers to Seeking Help

Some examples of barriers that prevent victims with disabilities from reporting and/or seeking help include:

Lack of accessibility to services (reliance on abusive caregivers to access resources, social isolation, communication barriers, etc.)
Situational factors (lack of needed services, lack of information about available services, etc.)
Fear of perceived consequences (retaliation by offenders, loss of independence, negative reactions by family, friends and professionals, etc.)
Socialization and educational factors (e.g., socialized to be compliant and depend on others for protection, manipulated to feel blame or uneducated about sexuality)

Strategies to Help Reduce Risk

Individuals should never be blamed or held responsible for their own victimization. However, increasing protective strategies for at-risk individuals has proven to be one way to help reduce the risk of victimization. Risk reduction is also the responsibility of service providers, as they can proactively identify resources and address obstacles to reporting and accessing services.

Examples of protective strategies for at-risk individuals (implementation may require the help of service providers):

Ensure access to communication methods (phone, Internet, etc.) if help would be needed.
Maintain access to assistive devices.
Minimize financial dependency on one person; include more than one person in financial arrangements.
Obtain and understand basic information on sexual violence, personal boundaries, personal safety and community resources.
Require that caregivers and/or guardians be screened.
Inform caregivers and other service providers that sexual assault will be reported to law enforcement and follow through with reporting.
Reduce isolation through multiple social connections that occur unscheduled in person or via the phone or Internet. Also maintain regular conversations with someone other than a caregiver to verify personal safety.
Have an individualized safety plan.

Examples of ways that organizations can increase access to their services:

Advertise their services in accessible formats in venues utilized by persons with disabilities.
Provide services at no or low-cost.
Partner with agencies serving victims with disabilities to provide education about available resources, their rights, sexuality, and healthy sexual relationships versus sexual violence.
Have the necessary resources available to communicate with victims seeking services, such as a picture board, capacity to hire an interpreter, etc.
Identify accessible resources to meet the needs of sexual violence victims and persons with disabilities.
Ensure the facility is accessible or arrange to provide equivalent services at an alternate site.
Train staff to appropriately respond to disclosures from victims with disabilities, provide crisis intervention and safety planning, support victims and quickly connect them with the resources they need.

Examples of ways service providers can work on a systemic level to reduce risk:

Change policies that limit victims' access to services.
Support local projects that increase safe, independent living opportunities for persons with disabilities.
Encourage policies and practices that will increase the safety of individuals with disabilities, such as screening policies for personal care attendants and guardians. • Increase awareness of the risk of sexual victimization to create a supportive social environment that encourages victims to speak out.
Provide cross-training to all disciplines involved in the service delivery system to ensure that victims with disabilities will be well served at all points of entry into the system

Indicators of Sexual Assault⁶

Because this crime is underreported, knowing the potential indicators of sexual violence can assist you in identifying victimization even when victims are reluctant to disclose. This knowledge can be particularly important if you work with persons with cognitive and communication disabilities who may have limited ability to understand or disclose their victimization.

Unless excessive physical force is used, most victims will not have visible physical injuries from the sexual assault. Coercion, intimidation and the threat of force can all be contributing factors as to why excessive force is not used in many assaults. The absence of physical evidence in no way correlates with the level of fear that victims may have experienced during the assault.

Physical indicators: The most common physical signs of a sexual assault include bruising (on the inner thighs or on the arms where the offender restrained the victim) and trauma to the genital area. Some physical signs are obvious, such as bleeding, and might require medical attention. Other physical indicators, such as pregnancy or a sexually transmitted infection, may be detected days or even weeks after the assault.

Behavioral indicators—examples include:

Self-harming behaviors: Increased drug and alcohol use, self-mutilation, and suicide attempt.
Changes in social interactions/ behaviors: Withdrawal; sexual promiscuity; dressing provocatively; wearing many layers of clothing; running away; aggressive or disruptive behavior; regressive behavior; sexually inappropriate behavior; excessive attachment; and avoidance of certain individuals.
Individual behavioral changes: Sleep disturbances/insomnia; excessive sleeping; change in eating patterns (bulimia, anorexia, weight gain); bed wetting; incontinence; aversion to touch; frequent bathing; avoidance of previously favorite places; compulsive masturbation; isolation; sudden unwillingness to undress or shower in front of a trusted person; and unexplained sexual knowledge inappropriate for developmental age.

Emotional indictors: Emotional trauma caused by sexual violence can manifest itself in numerous ways such as: depression; spontaneous crying; feelings of despair and hopelessness; anxiety and panic attacks; fearfulness; compulsive and obsessive behaviors; feelings of being out of control, irritable, angry and resentful; and emotional numbness. A specific type of emotional trauma, rape crisis syndrome, has been identified as a form of post-traumatic stress disorder specific to sexual violence victims.

Each person reacts differently to emotional trauma. It is critical that a service provider not judge a victim based on her response to the violence (e.g., do not assume she is unaffected by the assault if she is calm and seems in control of her emotions).

For more information on above topics, see B2. Indicators of Sexual Violence and B8. Understanding and Addressing Emotional Trauma in the WV S.A.F.E. Training and Collaboration Toolkit—Serving Sexual Violence Victims with Disabilities.

Mandatory Reporting

It may not always be clear to service providers who work with individuals with disabilities if they are mandated by West Virginia law to report sexual assault, which situations require a report, to whom they are required to report and how to go about reporting. Here are some of the basics:

In West Virginia, mandatory reporters of suspected abuse or neglect of adults who are incapacitated, or of emergent situations where adults who are incapacitated are at imminent risk of serious harm, include: medical, dental and mental health professionals; Christian Science practitioners; religious healers; social service workers; law enforcement officers; humane officers; state or regional ombudsmen; and employees of nursing homes or other residential facilities. Check with your supervisor to if you are unsure if you are a mandatory reporter.
An adult who is considered "incapacitated," according to state law, is someone who cannot independently conduct daily life sustaining activities due to a physical, mental or other infirmity.⁷ Abuse, neglect or an emergent situation involving an adult who is incapacitated should be reported to the local Department of Health and Human Resources (DHHR), Adult Protective Services (APS), or the 24-hour hotline provided for this purpose (800-352-6513).
Mandatory reporters of suspected or observed mistreatment of a minor in West Virginia include: medical, dental or mental health professionals, religious healers and members of the clergy, Christian Science practitioners, social service workers, school teachers and other school personnel, child care or foster care workers, humane officers, emergency medical services personnel, peace officers or law enforcement officials, circuit court and family court judges, employees of the Division of Juvenile Services and magistrates.⁸ Reports should be made to DHHR, Child Protective Services (CPS), or 800-352-6513 (same as above number).
The initial verbal report to DHHR should be followed within 48 hours with a written report, using DHHR's forms or forms your agency has developed for this purpose.

For more information on this topic, see B5. Mandatory Reporting, in the WV S.A.F.E. Training and Collaboration Toolkit—Serving Sexual Violence Victims with Disabilities.

Confidentiality

Information should not be released about victims (except to DHHR in cases requiring mandatory reporting) without their informed, written consent.
Release of information forms used by your agency should be time-limited and specific.
Special conditions regarding release of information and informed consent exist for minors and some incapacitated adults with cognitive disabilities. Minors are typically unable to legally provide informed consent. Therefore, when the client is a minor, the written release of information should be signed by the minor where possible and the non-abusive parent or guardian of the child. Emancipated minors, however, can make most of their own decisions and do not need the signature of their parent or guardian.⁹ With adults who are incapacitated, the issue is whether they are competent to give consent. If a client is not capable of providing consent to release information, the written release should be signed by the client where possible and the non-abusive guardian, if that person exists. In West Virginia, a person is legally considered to be competent unless a court has determined otherwise.

For more information on this topic, see B6. Confidentiality in the WV S.A.F.E. Training and Collaboration Toolkit—Serving Sexual Violence Victims with Disabilities.

Initial Response

If an individual with disabilities discloses sexual victimization, (1) quickly gather information from the victim about the situation, (2) provide a safe environment for the expression of feelings and stabilize the victim's reactions to the trauma, (3) help the victim identify any urgent needs and discuss options for meeting those needs, and (4) offer assistance in safety planning.

Your initial response should be based on the victim's self-identified needs rather than your professional opinions and/or family members' concerns. To the extent possible, a victim should make her own choices about how to address any identified needs and concerns.

Convey that you believe her, the sexual assault was not her fault, and that you can assist in getting help. Respect and accommodate the methods and pace of communication and the needs, abilities and experiences of the victim.
Ask the victim about any safety concerns (for herself, family, friend, service animals, etc.). Ask her to be specific. Validate her concerns. In the case of imminent danger, call 911 as per your agency's policy.
Ask the victim "Is there anything I should know that will enable me to better assist you?" If the victim discloses having a disability, it is helpful for you to identify any concerns she has related to how the disability may affect her reactions to the assault, her safety, and/or her ability to access services, as well as what accommodations would be useful. Note that it may be difficult for her to identify if and how a disability impacts the situation (e.g., because she has not considered this issue before, has trouble comprehending the extent of the danger posed and/or is unaware of available services). Provide support in talking through this issue.
Discuss medical needs. If the assault was recent, explain the importance of getting immediate attention for injuries as well as for the prevention of sexually transmitted infections and/or pregnancy (if applicable). Help facilitate medical care for the victim as per your agency's policy.
Discuss reporting options. Explain that, in West Virginia, a victim can decide whether or not to report a sexual assault to law enforcement, unless the situation meets the criteria for mandatory reporting requirements. If a mandatory report is required, encourage the victim to initiate the report herself and offer assistance in reporting.
Explain the need for evidence collection. Forensic evidence can play a key role in case investigation and prosecution. Forensic evidence collection from the victim's body and clothing should take place as soon as possible after a sexual assault. In West Virginia, victims can have a forensic medical examination to assess medical needs and collect evidence. Offer to coordinate with other responders to facilitate this exam.
- Explain what happens during the exam, the availability of a victim advocate to be with her during the exam, medical facility options and options for transportation to a medical facility. Encourage the victim to let responders know how to best accommodate her needs.
- Explain how to preserve bodily evidence until it can be collected, depending on the area of the body that was assaulted (e.g., do not wash, change clothes, urinate, defecate, smoke, drink, eat, brush hair or teeth, or rinse mouth). Explain that in suspected cases of drug/alcohol facilitated sexual assault, the first available urine should be collected and brought to the medical facility if she cannot wait to urinate until arrival at the facility. Explain that since her clothing may be taken as evidence, she may wish to arrange to have a change of clothes at the medical facility.
- Explain who pays for the exam. In WV, the state covers the forensic costs if the exam is conducted within 96 hours of the crime. Victims are responsible for non-forensic/treatment costs.
- Explain that a forensic medical exam can be conducted within 96 hours of the crime even if the victim has not decided about reporting the sexual assault to law enforcement. There is no statute of limitations on reporting sexual assault. Collected evidence in a non-report will be stored for up to 18 months.
- Explain that if the sexual assault was not recent, victims can still access medical care, advocacy and other services. The crime can still be reported to law enforcement and a discussion held with responders whether evidence might be available to corroborate the victim's account of the sexual assault.
Identify additional concerns of the victim and help prioritize them. For example, she may have questions and concerns about whether what happened to her was illegal, about the cost of medical treatment, about how to preserve evidence, about what will happened during the forensic medical exam, or about others' reactions to the assault. For the most urgent concerns, consider discussing immediate options.
Ask the victim if you can help her develop a plan to address her immediate safety needs (for her and her dependents, pets and service animals as applicable to the situation). The plan should identify specific tasks, persons and resources that can help meet her needs. These could include:
- Specific steps the victim can take to address immediate safety concerns. Offer assistance in brainstorming creative solutions to safety that are within her abilities and resources.¹⁰
- Supportive persons whom the victim can turn to for help with safety needs and their potential roles.
- Specific safety strategies that may prove difficult to achieve and accommodations available to reduce or eliminate these barriers.
- Essential items needed, if time and safety allow, when the victim has to flee from her current location (e.g., medications, assistive devices, information about services and financial benefits, key insurance and legal documents, money, caseworker's name and phone number, information about a legal guardian, etc.) and any assistance needed to obtain these items.
Provide referrals to community resources to meet the victim's urgent needs. As appropriate, ask if you can immediately connect her with agencies to help her cope with the situation (e.g., to the local rape crisis center).
Encourage the victim to follow up to let you know how she is doing and to develop a longer-term plan for safety and other assistance.

For more information on this topic, see B9. Crisis Intervention, B10. Safety Planning and B11. Sexual Assault Forensic Medical Examination in the WV S.A.F.E. Training and Collaboration Toolkit—Serving Sexual Violence Victims with Disabilities.

Tips for Communications

General considerations when communicating with persons with disabilities include:¹¹

Communication involves speech, language and processing. Different types of disabilities impact communication differently. Cognitive disabilities, for example, impact the processing of information and not necessarily the speech. The same communication methods or assistive devices will not be appropriate for every type of disability.
A person who has a disability is entitled to the dignity, consideration, respect and rights you expect for yourself.
Use "person first" terminology that places the person before the disability (instead of "an epileptic," use "a person with epilepsy"). Note that person first language that is acceptable to individuals with disabilities can change over time. Also, some persons with disabilities may prefer terminology that is not person first language, while others find that person first language makes speaking and writing complicated. For these reasons, simply asking the person what terms she prefers is often the best course of action.
Take the time needed to listen and understand the situation. If your agency has a policy regarding standard session times, adaptations may need to be made. Shorter sessions over longer periods may reduce frustration for some clients. Adapt to the individual; not everyone will need extra time.
Relax. Allow the person who has a disability to help identify the support she needs from you.
If you offer assistance and the person declines, do not insist. If it is accepted, ask how you can best help, and then follow her direction. Do not take over.
If someone with a disability is accompanied by another individual, address the person with the disability directly rather than speaking "through" the other person.
In general, if an individual is upset, she will be more difficult to understand. For a victim of sexual violence, it might be helpful to initially talk about something other than the trauma that she experienced to become familiar with her communication patterns. Sometimes working as a team can be helpful in trying to understand a client, as long as it is not embarrassing for the client—either by asking if there is someone the client trusts to assist or by involving someone else on your staff.
Speak naturally. It is fine to use common expressions like "I see" or "see you later" with a person who is blind, or "let's walk over here" with a person who uses a wheelchair.
When communicating with an individual who uses a wheelchair, sit at her level. Do not touch the wheelchair and, if you inadvertently bump into the wheelchair, excuse yourself as you would if you bumped into another person.
Have a plan for the next steps in communicating.
Be honest. It is acceptable to tell a person you do not understand the message she is trying to communicate to you. Ask if there is anything you can do to make the interaction better.¹²

It is helpful to determine the relationship between the suspected offender and the victim. If the offender is the victim's caregiver or a family member, you will need to know what the relationship means to the victim in terms of practical and emotional issues. For example, does the victim depend on the caregiver to communicate with others? Does the victim fear if she loses her caregiver, she may be forced into an assisted living situation?

For more information on this topic, see C2. Person First Language and C3. Tips for Communicating with Persons with Disabilities in the WV S.A.F.E. Training and Collaboration Toolkit—Serving Sexual Violence Victims with Disabilities.

Accommodations

Accommodations are often essential to allow a sexual assault victim with disabilities to access and benefit from available services. An "accommodation" is a broad term that is used to describe a modification to goods, services and structures that allows for inclusion and participation by a person with disabilities. Some common accommodation tools to modify goods and services include:

Auxiliary aids and services is a term used by the U.S. Department of Justice to describe a wide range of services and devices that promote effective communication.¹³
Assistive technology (AT) refers to any device used to perform a task that would otherwise be difficult or impossible due to a disability. We all use AT devices every day. An electric can opener is easier to use for some than a hand- held can opener. Glasses make it possible for those with less than perfect vision to read. Computers and technology assist us in communicating and in gaining knowledge without physically leaving our current locations. There is some overlap between auxiliary aids and AT devices.
Personal services refer to a wide range of services and providers available to assist individuals with daily living tasks that they cannot accomplish on their own (e.g., an attendant from a home health agency may assist a person with physical disabilities with bathing and dressing).

In order to find out if accommodations are required and what accommodations are appropriate, ask each client with disabilities what she needs to access services. What is effective for one could be ineffective for another.

For more information on this topic, see C4. Accommodating Persons with Disabilities, in the WV S.A.F.E. Training and Collaboration Toolkit—Serving Sexual Violence Victims with Disabilities.

Self-Advocacy

If a person with a disability is a victim of sexual violence, self-advocacy can be critical to her recovery. As self-advocates, individuals speak up for themselves, make their voices heard and views known, make their own choices and advocate for their rights. You can work with the individual to build her self-advocacy skills. Because victimization often involves the sense of a loss of power, supporting a victim in her actions, rather than acting on her behalf, helps her regain control.

Factors that are likely to prevent a person from obtaining skills that promote self-advocacy include:¹⁵ lack of opportunities for peer education and support; lack of access to information on self-advocacy, self-determination and leadership development; lack of opportunities to make decisions and take risks; low expectations of their capacity to know what is best for them and how to get their needs met;¹⁶ and the existence of societal attitudes that marginalize or devalue people with disabilities. For a sexual assault victim, another factor is the lack of knowledge of available resources related to victimization and the lack of support to report the crime because the perpetrator may be a family member, acquaintance or a caregiver.

A key factor for a person with a disability to overcome these barriers and become a self-advocate is self-awareness—knowing her strengths and challenges and how her disability affects both her and how she interacts with others.

The "dignity of risk" means respecting an individual's choices, as long as her actions are not harmful to herself or others.¹⁷ Not allowing an individual to take risks means denying a basic educational tool in life—learning from experience and using that knowledge in future opportunities.

For more information on this topic, see C6. Self-Advocacy and Victims with Disabilities, in the WV S.A.F.E. Training and Collaboration Toolkit—Serving Sexual Violence Victims with Disabilities.

Guardianship and Conservatorship

In the course of your work, you may interact with victims who have or may need guardians and/or conservators to make decisions on their behalf. The following information may be useful:

If an adult in West Virginia lacks the ability to make personal and/or financial decisions, it may be determined by the court that they are a "protected person" and need a guardian and/or conservator to be appointed to make these decisions on their behalf. A guardian is a person appointed by the circuit court who is responsible for the personal affairs of a protected person. A conservator is a person appointed by the circuit court who is responsible for managing the estate and financial affairs of a protected person. The terms and conditions of the court order of appointment indicate the scope and limitations of the guardianship/conservatorship.
In order for a guardian or conservator to be appointed, a petition must be filed in circuit court in the county where the potentially protected person resides. Any interested person may file this petition. A hearing is scheduled within 60 days of filing. Based upon information presented during the hearing, the court determines if the individual is to be considered a protected person; the person's limitations; development of the person's maximum self-reliance and independence; whether a guardian/conservator should be appointed; the type of guardian/conservator and specific areas of protection, management and assistance to be granted; the suitability of the proposed guardian/conservator; and the length and other terms and conditions of the order. Prior to appointment, the guardian/conservator must complete mandatory training. The court monitors the appointment through periodic reports by the guardian/conservator. This process is intended to pursue the least intrusive type of appointment necessary to meet the person's needs.
If you suspect abuse or neglect of a protected person by a guardian/conservator and are a mandatory reporter, you are required to report your suspicions to the Department of Health and Human Resources (DHHR) or the statewide hotline at 800-352-6513. If you suspect a crime has been committed against a protected person, call local law enforcement. If you think a protected person is in imminent danger, call 911. If you suspect a guardian/conservator is not acting in the protected person's best interest, contact the circuit court that appointed the guardian/conservator or a private attorney for information on options. In cases in which DHHR is the appointed guardian, contact DHHR.
If a client has a guardian/conservator, you must clarify the terms and conditions of the appointment. You need this information before making decisions to release client information to a guardian/conservator. You also must consider whether you need the permission of the guardian/conservator to release client information to other providers or to provide specific services to the client.

For more information on this topic, see C7. Guardianship and Conservatorship, in the WV S.A.F.E. Training and Collaboration Toolkit—Serving Sexual Violence Victims with Disabilities.

References

¹ Although males and females are both victimized by sexual violence, most reported and unreported cases are females (C. Rennison, Rape and sexual assault: Reporting to police and medical attention, 1992-2000 (Washington, DC: Bureau of Justice Statistics, Office of Justice Programs, U.S. Department of Justice, 2002), 1, http://bjs.ojp.usdoj.gov/index.cfm?ty=tp&tid=92; and P. Tjaden & N. Thoennes, Prevalence, incidence and consequences of violence against women: Findings from the National Violence Against Women Survey (Washington, DC: National Institute of Justice, Office of Justice Programs, U.S. Department of Justice, 1998), 2-4, http://www.ojp.usdoj.gov/nij/publications/welcome.htm. Regarding sex offenders, males make up the vast majority, but females also commit sexual crimes. In 1994, less than 1 percent of all incarcerated rape and sexual assault offenders were female (L. Greenfeld, Sex offenses and offenders: An analysis of data on rape and sexual assault, U.S. Department of Justice, Bureau of Justice Statistics (Washington, DC: 1997). As cited in R. Freeman-Longo, Myths and facts about sex offenders (Center for Sex Offender Management, 2000), http://www.csom.org/pubs.
² 2008 WV Behavioral Risk Factor Surveillance System Survey.
³ 2008 WV Behavioral Risk Factor Surveillance System Survey.
⁴ D. Kilpatrick, Rape and Sexual Assault, 2000.
⁵ M. Ticoll, Violence and people with disabilities: A review of the literature (Ontario: L'Institut Roeher, National Clearinghouse on Family Violence, Family Violence Prevention Unit, Health Canada, 1994), http://www.phac-aspc.gc.ca/ncfv-cnivf/publications/fvdisabliterature-eng.php; and Day One: The Sexual Assault and Trauma Resource Center, Rhode Island Coalition Against Domestic Violence and PAL: An Advocacy Organization for Families and People with Disabilities, Is your agency prepared to ACT? Conversation modules to explore the intersection of violence and disability (Advocacy Collaboration Training Initiative, 2004).
⁶ The information on indicators is compiled from: N. Baladerian, Survivor, book III. For family members, advocates and care-providers (Baladerian, 1985), 4; Building partnerships for the protection of persons with disabilities, Protect, report, preserve: Abuse against persons with disabilities (Massachusetts District Attorneys Association, 2006), 11-12; and et al., 34, section adapted from Wisconsin Coalition Against Sexual Assault, Transcending silence: A series about speaking out and taking action in our communities (2001).
⁷ As per WVC§9-6-9.
⁸ DHHR website on reporting child abuse and neglect, http://www.wvdhhr.org/bcf/children_adult/cps/report.asp
⁹ WVC§49-7-27.
¹⁰ C. Hoog, Enough and yet not enough: An educational resource manual on domestic violence advocacy for persons with disabilities in Washington state, 83-90 (Olympia, WA: Washington State Coalition Against Domestic Violence, 2003), http://www.mincava.umn.edu/documents/wscdv/wscdv.pdf.
¹¹ These considerations/tips were primarily excerpted/slightly adapted from Adaptive Environments Center, Inc., Fact sheet 3, Communicating with people with disabilities (1992), through http://www.adata.org/. Most are also mentioned in the film/accompanying written material, I. Ward & Associates, Ten commandments of communicating with people with disabilities (1994).
¹² Day One et al., 8.
¹³The Americans with Disabilities Act, Title II technical assistance manual II-7.1000, Equally effective communication, through http://www.ada.gov/taman2.html.
¹⁴ Title II technical assistance manual II-7.1100, Primary considerations.
¹⁵ Drawn in part from J. Johnson, Leadership and self-determination, Focus on Autism and Other Developmental Disabilities, 14(1) (1999), 4-16.
¹⁶ This factor is from B. Mitchell, Who chooses?, National Dissemination Center for Children and Disabilities transition summary, 5 (1988), as included in STIR (Steps Towards Independence and Responsibility) and Shifting the Power, Speak up! guide (Chapel Hill, NC: Clinical Center for the Study of Development and Learning, University of North Carolina), 18-22, access through http://www.selfdeterminationak.org/toolkit/speak_up_guide/.
¹⁷ Drawn from Day One et al., 16.