Presentation Transcript

1. Preventing Abuse and Neglect: New Approaches to Stopping Harm

   Griffith University Endeavour Foundation Brisbane, Queensland, April 11, 2011 Nancy M. Fitzsimons, PhD, MSW Minnesota State University, Mankato Nancy.fitzsimons@mnsu.edu
2. New approachesrequires us to be intentional in our use of the word prevention. What do we mean when we use the word “Prevention”? What does it mean to preventabuse and neglect? Are we intentional in the use of the word “prevention”? Why does the answer to any of these questions matter?
3. Levels of Prevention: Primary Prevention Primary preventionactivities focus on removing the root cause before the social problem has occurred to prevent initial perpetration or victimization. Strategies are aimed at changing cultural norms, attitudes and polices that reinforce and perpetuate violence and abuse. (CDC, 2004; Chamberlain, 2008; McMahon, 2000)
4. Levels of Prevention: Secondary Prevention Secondary preventionactivities focus on the immediate responses after the social problem as occurred. Efforts aim to prevent re-victimization and to deal with the short-term consequences of violence abuse and to stop perpetrators from re-offending through early identification and intervention. (CDC, 2004; Chamberlain, 2008; McMahon, 2000)
5. Levels of Prevention: Tertiary Prevention Tertiary preventionfocuses on the long-term responses to the social problem after it has occurred to deal with the lasting consequences of victimization, restore victim/survivor health and wellness prevent perpetrators from re-offending through treatment, incarceration, & other forms of monitoring & containment. (CDC, 2004; Chamberlain, 2008; McMahon, 2000)
6. Targets of Prevention Universal prevention – target is the general public Help bystanders to get involved Change social norms, attitudes, belief system Selective prevention – people at higher risk than average Target people with disabilities Target family members, carers & others Indicated prevention – highest risk individuals or groups Target people warning signs of abuse, suspect abuse Target high risk people in the lives of people with disabilities Evidence high-risk offender characteristics; history of abusing (Chamberlain, 2008)
7. New approaches requires us to understand the problem from anEcological Perspective. (Anetzberger, 2005; Brandl, 2000; Brandl & Raymond, 2005; Rodriguez & Murphy, 1997; Sobsey, 1994; Hollomotz, 2009)
8. Integrated Ecological Theory of Abuse (Originally proposed by Sobsey, 1994; adapted by Fitzsimons, 2009)
9. Integrated Ecological Theory of Abuse: Characteristics of Higher Risk Victims (Sobsey, 1994; Fitzsimons, 2009; Davies & Jenkins, 2004; Fischer & Field, 1985; Petersilia, 2001) Less able to physically defend self Relies on alternative forms communication/ communication difficulties Lack critical information Learned helplessness Learned compliance Underdeveloped sense of personal space/boundaries Dependent upon others Desire to please or be accepted by others Few alternative to exploitation Little control over lives Viewed negatively by others Engage in “problematic” behaviors Multiple care providers Multiple service settings Not viewed as a credible reporter of abuse
10. Assessing Vulnerability: Risk Factors and Protective Factors Maria is a 44-year-old woman with a diagnosis of cerebral palsy. She does not have an intellectual disability. She has difficulty communicating verbally. She prefers to use her computer with a head pointer to communicate in writing. Maria is unable to walk and has limited use of her arms. She uses a power wheelchair. For the past three years Maria has lived in her own apartment with the support of the same live-in personal assistant (PA). The local Center for Independent Living (CIL) assists Maria in hiring and managing her PA. Prior to moving into her own apartment, Maria lived in a nursing home. She also lived in a state-run institution from ages 11 to 22. She received limited formal education. She was taught to read by her mother. Maria depends on her PA for all of her daily living needs, including recharging the battery on her power wheelchair, putting on her head pointer to use her computer, and connecting her computer to the telephone. Her 69-year-old mother visits her three to four times per week. Maria also has two sisters; both live out of town and visit four to five times per year. She communicates with her sisters on Facebook and by e-mail every day.
11. Integrated Ecological Theory of Abuse: Characteristics of High Risk Carers/Offenders (Sobsey, 1994; Fitzsimons, 2009; Parley, 2010; Marsland, Oakes, & White, 2007 Need to exert control over others Lack of control over own life Authoritarian Low self-esteem Displaced aggression Don’t respect confidentiality/right to privacy & autonomy Exposed to abusive models Little attachment to potential victims Devaluing attitudes towards people with disabilities Impulsive behaviors
12. Classification of Offenders(Petersilia, 2001) Predatory Offenders people who seek employment or relationships with people that they perceive of as vulnerable Corrupt Carers people who start out as well-meaning, have good intentions, and typically do not plan to abuse. Bystanders(Katz, 2006) An “enabler” someone who is not directly involved as a perpetrator of abuse, but is indirectly involved as a family member, friend, carers–– but fails to get involved.
13. Integrated Ecological Theory of Abuse: Characteristics of High Risk Environments(Sobsey, 1994; Fitzsimons, 2009; McCarthy & Thompson, 1996; White et al., 2003; Marsland, Oakes, & White, 2007; Calcraft 2007; Wardhaugh & Wilding, 1993) Emphasizes control Teaches/reinforces compliance Attracts abusers Eliminates non-abusers Provides awarded models of aggression Covers-up reports of abuse Many /transient carers Dehumanizing policies and practices Clusters people with greatest risk Discourages attachment Isolation Fails to protect reporters Closed culture – little input from outside org. Justifies abusive practices as “behavior management” Unjust balance of power Discourages friends/visitors Readily accepts excuses for abuse
14. Typical Abuse “So-Called Prevention” Training(Davies & Jenkins, 2004) Understanding the law Definition of a “vulnerable adult” Acts or behaviors that constitute abuse Policies related to “mandatory” reporting Definition of mandated reporter Immunity Consequences for failure to report Confidentiality of reporter When to report What information to give when making a report Who to call What to Expect from Adult Protective Services (or other investigative agencies)
15. New Approaches: Comprehensive Training with a Primary Prevention Focus(Dehart, Webb & Cornman, 2009) The competencies are divided into four broad categories: Definitions and policies Risks for Abuse from an Ecological Perspective, including: Identify environmental context that creates a risky climate for abuse Identify carer attitudes and behaviors that create a risky climate for abuse Identify resources and coping strategies for addressing personal stressors so that these do not carry over to create abuse risk in interpersonal relationships/caregiving.
16. New Approaches: Comprehensive Training with a Primary Prevention Focus(Dehart, Webb & Cornman, 2009) Communication and Respect in Relationships, including Describe the inherent power differential between people with disabilities and carers and implications for abuse Share core values to caregiving, including concern for humankind, compassion, and empathy, protecting those who cannot protect themselves, respecting clients right to privacy, dignity, self-determination. Cooperative Work Environment, including Justify teamwork as part of a supportive work environment, including appreciation and respect among coworkers, pride in one’s work, and cooperative efforts to promote quality service. Identify strategies for offering or requesting assistance from other carers when conflicts or heavy workloads pose risk of abuse
17. Integrated Ecological Theory of Abuse: Societal Characteristics – Culture, Policies, Systems (Calderbank, 2000: Sobsey, 1994; Kohn, 2009) Devalues people with disabilities Laws, policies and procedures that disempower people with disabilities Limit autonomy Ex: Mandated reporting Teaches/reinforces compliance Emphasizes vulnerabilities Reinforces control, power imbalances, aggression Denies problems Supports institutional & segregated systems of support and care Discourages solutions targeting root cause Promotes “them” and “Us” mentality
18. The Limitations of the Adult Protection Model A response model – not a primary prevention model Modeled after child protection legislation/system Paternalistic approach Vulnerability often based on classification, rather than individual’s ability to make informed decisions about own life Limits autonomy, self-determination Mandated reporting Ineffective May increase risk Discourages telling/seeking help (Kohn, 2009; Saxton et al., 2006; Sin et al., 2009;, Sobsey, 1994)
19. New Approaches: Reconceptualize the Problem – Crimes!! U.S. Department of Justice Office of Violence Against Women (n.d.) Disability Grant Program to support creation of multidisciplinary coordinated community response teams Office for Victims of Crime (OVC, 2008) Promising Practice in Serving Crime Victims with Disabilities to improve local response of victim services and criminal justice personnel to crime victims with disabilities.
20. New Approaches: Reconceptualize the Problem – Crimes!! U.S. Department of Justice Office for Victims of Crime National Crime Victims with Disabilities Conference. Bureau of Justice Statistics (OVC, 2008) National Crime Victimization Survey (Rand & Harrell, 2009; Harrell & Rand, 2010) Ask about disability status Issue reports focused on crimes against people with disabilities
21. New Approaches: Community Engagement/Bystander Approach A bystander is someone who is not directly involved as a perpetrator or victim of an act of interpersonal violence, but is indirectly involved as a family member, friend, care provider – really anyone who has the opportunity to witness or becomes aware of interpersonal violence – yet fails to get involved.
22. New Approaches: Community Engagement/Bystander Approach Green Dot approach to ending power-based violence Green dot is “any behavior, choice, word, or attitude that promotes safety and makes it clear that we won’t put up with violence.” Red dot is someone who perpetrates acts of violence or an individual who chooses to do nothing in the face of a violent situation. (Edwards, 2009)
23. Core Principle Behind Green Dot “No one has to do everything, but everyone has to do something”. (Edwards, 2009) http://www.livethegreendot.com
24. Notable Quote “No epidemic has ever been cured by focusing on the affected individual.” Dr. George Albee (Distinguished psychologist)
25. New approaches requires us to use an Ecological Model of Prevention N. M. Fitzsimons, PhD, MSW - Minnesota State University, Mankato
26. The Prevention Institute http://www.preventioninstitute.org/tool_spectrum.html(Cohen & Swift, 1999)
27. New Approaches: Develop a Comprehensive Prevention Plan
28. I did then what I knew then, when I knew better, I did better. Maya Angelou
29. My Contact Information Nancy M. Fitzsimons, PhD, MSW Nancy.fitzsimons@mnsu.edu 507-389-1287 Minnesota State University, Mankato Department of Social Work 358 Trafton Science Center North Mankato, MN 56001