State abuse response: It has to be about the person

Betty Schwieterman
Director of Systems Advocacy

"It has to be about the person." 

George Adams attends a DSHS convened subcommittee which will make legislative recommendations to improve the state response to the abuse and neglect of people with disabilities and elders. Adams represents disability advocacy organizations, Self-Advocates of Washington and Self-Advocates in Leadership on the subcommittee. 

Jane Beyer, then Interim Aging and Disability Services Administration Assistant Secretary, in December 2012 created the subcommittee in response to a DRW report “Too Little Too Late: Ending the tolerance of abuse and neglect”. The subcommittee has been meeting monthly. 

Multiple times throughout each meeting, Adams said he finds himself thinking, “It has to be about the person,” meaning the person who has been abused or neglected.

However, meeting discussions are often focused on service providers, caregivers, regulations, and even occasional excuses for, and acceptance of, abuse and neglect.

Workers may be fired after an incident of abuse but not investigated by the state at all. If the state does investigate, it may be many months or even a year later. In the meantime these workers are free to continue work in the long term care system.  A service provider may have multiple citations for medication errors and still be allowed to continue providing service, even when they fail to improve their practices. 

Adams is saddened by the stories he hears about people with disabilities suffering sexual and physical assault, serious medication errors, and verbal abuse at the hands of their supposed care givers. And he is mad.

"When abuse does happen the person accused should not be able to be around people with disabilities and providers who have a history of giving a person the wrong medication again and again and again they should not be in business," said Adams.

After listening to the stories of abuse and neglect happening to people with disabilities and elders, Adams said, “Abuse, neglect, and sexual abuse should not be happening at all, but when  a person is abused, they need to have people they can trust to help them, they need to have choices for services to help them recover.”

"Most importantly the person who was abused or neglected must have services they need to recover," he added.

Adams is talking about services like counseling, safety planning, the option to move, protection from additional abuse or neglect or other services that help a person regain their sense of well-being. These are known as trauma-informed care or services.   There is growing recognition of the need for trauma informed care in the service and advocacy systems for survivors of violence, sexual violence, abuse and neglect. The Trauma-Informed Organizational Toolkit, developed by the National Center on Family Homelessness identifies the principles of trauma informed care

The subcommittee is wrapping up its work in August 2013 and made several recommendation to the legislature and to DSHS. So far the subcommittee is listening to Adam’s concerns.

The subcommittee identified a problem in the current response to abuse and neglect:

“There are limited strategies and resources to assist an alleged victim of abuse, neglect or exploitation.  Victims should be approached and supported in a way that recognizes and addresses the trauma associated with the incident(s).”

And it made a recommendation:  

“Clarify DSHS response to abuse and neglect includes addressing trauma recovery in addition to providing for safety.  Identify budget proposal to see what it would take to expand/provide this, particularly for people not receiving case management.  Provide training and technical assistance to case managers and providers on trauma-informed care.”

DRW and several subcommittee members will continue to work with DSHS, to implement this recommendation and focus abuse and neglect response on what a person needs to recover. 

National research confirms abuse, neglect and violence are a major problem for people with disabilities. Research consistently shows that women with disabilities regardless of age, race, ethnicity, sexual orientation, or class are assaulted, raped, and abused at a rate two times greater than women without disabilities. (Sobsey, 1994; Cusitar, 1994) The risk of being physically assaulted for an adult with developmental disabilities is 4-10 times higher than for other adults. (Sobsey, 1994; Cusitar, 1994) The Bureau of Justice Statistics’ report, Crime Against People with Disabilities, 2008 (NCJ 231328), found the violent crime rate against persons with disabilities was double the violent crime rate for persons without disabilities. Among the types of disabilities measured in 2008, persons with cognitive disabilities had the highest risk of violent victimization.  

A study funded by the National Institute on Aging found that, “Even when adjustments were made to account for chronic diseases, social conditions and other conditions associated with increased death rates among the elderly, mistreated older persons were three times more likely to die than older persons who were not mistreated.” (Lachs et al., 1998)

The principles of trauma informed care

  • Promoting Safety - Establishing a safe physical and emotional environment where basic needs are met, safety measures are in place, and provider responses are consistent, predictable, and respectful.
  • Ensuring Cultural Competence - Understanding how cultural context influences one’s perception of and response to traumatic events and the recovery process; respecting diversity within the program, providing opportunities for consumers to engage in cultural rituals, and using interventions respectful of and specific to cultural backgrounds.
  • Supporting Consumer Control, Choice, and Autonomy - Helping consumers regain a sense of control over their daily lives and build competencies that will strengthen their sense of autonomy; keeping consumers well-informed about all aspects of the system, outlining clear expectations, providing opportunities for consumers to make daily decisions and participate in the creation of personal goals, and maintaining awareness and respect for basic human rights and freedoms.
  • Sharing Power and Governance - Promoting democracy and equalization of the power differentials across the program; sharing power and decision-making across all levels of an organization, whether related to daily decisions or in the review and creation of policies and procedures.
  • Integrating Care - Maintaining a holistic view of consumers and their process of healing and facilitating communication within and among service providers and systems.
  • Healing Happens in Relationships - Believing that establishing safe, authentic, and positive relationships can be corrective and restorative to survivors of trauma.
  • Recovery is Possible - Understanding that recovery is possible for everyone regardless of how vulnerable they may appear; instilling hope by providing opportunities for consumer and former consumer involvement at all levels of the system, facilitating peer support, focusing on strength and resiliency, and establishing future-oriented goals.
Freedom from abuse and neglect