Victims with Disabilities

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Overview for Service Providers

In the course of your work, you may encounter victims of sexual violence who have a cognitive, sensory or mobility disability or a mental illness. Like any victim of sexual assault, people with disabilities who experience sexual violence may feel powerless, vulnerable and afraid. In addition, many factors can complicate disclosing the assault to others, reaching out for help and accessing services.

To enhance the assistance you provide to them, you can 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 more information on this topic, see the WVFRIS Sexual Assault Training Academy (SASTA) for an online course, Serving Victims with Disabilities.

What to Know

Prevalence

  • Rates of sexual victimization for individuals with disabilities are higher than for those without disabilities.
    • Nationally, individuals 12 years and older with disabilities experience rape and sexual assault at rates more than 4 times higher than those without disabilities (Harrell, 2021).
    • Children with disabilities are 3 times more likely than those without disabilities to be victims of sexual abuse (Lund & Vaughn-Jensen, 2012; Smith & Harrell, 2013).
    • West Virginia has the highest rate in the nation of residents with a disability, at almost 20% of the population (Erickson, Lee & von Schrader, 2017). Rates of sexual victimization are higher for WV residents who have a disability (14%) than for those without a disability (almost 10%) (WV Bureau for Public Health, 2008).
    • Rates of violent crime victimization, including rape and sexual assault, are more than 3 times higher for males with disabilities than those without disabilities, and almost 4.5 times higher for females with disabilities than those without disabilities. For whites, blacks, Hispanics, and persons of other races, the rate of violent victimization for persons with disabilities was at least triple that of persons without disabilities. (Harrell, 2021).
    • College students with disabilities have higher rates of sexual victimization than those without disabilities. The risk is highest for female and transgender students with disabilities. (Cantor et al., 2019)
    • People with mental and physical disabilities are at elevated risk of being sexually victimized by intimate partners, compared to those without disabilities (Brownridge, 2006).
  • Risk for sexual victimization is even higher for persons who have certain types of disabilities and those with multiple and more severe disabilities.
    • Disability types associated with higher rates of sexual victimization include intellectual, cognitive and mental health disabilities (Lund & Vaughn-Jensen, 2012; Smith & Harrell, 2013; Harrell, 2021).
    • Rates of sexual victimization against persons with a single disability are lower than for those with multiple disabilities (Herrell, 2017). People with multiple and more severe disabilities are more at risk for physical and sexual victimization compared to individuals with single or less severe disabilities (Brunnberg, Boström, & Berglund, 2012; Casteel et al., 2008).
    • College students with chronic mental health conditions or two or more disabilities were particularly at risk. (Cantor et al., 2019)
  • More than victims without disabilities, those with disabilities tend not to report sexual victimization to authorities or otherwise seek help. Harrell (2021) found that 36% of rapes or sexual assaults against persons without disabilities are reported to police, compared to 19% against those with disabilities.
  • When victims with disabilities do seek help or report, they may encounter communication, physical, programmatic and attitudinal barriers to getting help or obtaining justice (Smith, Harrell, Smith & Demyan, 2015).

Risk Factors

So, gender, type and severity of disability, and number of disabilities factor into risk of sexual victimization for persons with disabilities. Other common risk factors for persons with disabilities (Drawn from Ticoll, 1994; Day One et al., 2004):

  • Reliance on others for care, assistance with personal needs and/or management of their affairs
  • Social isolation
  • Communication barriers
  • Lack of accessible transportation
  • Learned compliance of people with disabilities
  • Lack of knowledge about sexuality and/or healthy intimate relationships
  • Poverty and lack of resources/knowledge of resources  

Negative public attitudes toward persons with disabilities also are community/societal risk factors, as such attitudes may lead perpetrators to view this population as an easy target and consider it unlikely that their actions will result in a conviction.

Barriers to 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)  

Indicators of Sexual Assault

(Drawn from MA District Attorneys Association, 2006; WI Coalition Against Sexual Assault, 2001; Baladerian, 1985)

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 have limited ability to understand or disclose their victimization.

  • Physical indicators: Some common physical signs of a sexual assault include bruising (e.g., on the inner thighs or on the arms where the offender restrained the victim) and trauma to the genital area. Sometimes, physical signs are obvious, such as bleeding, and might require medical attention. Other physical indicators, such as pregnancy or a sexually transmitted infection, may not be detected till days or weeks after the assault.
    • Note that 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 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.
  • 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 indicators: 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. Many victims suffer from post-traumatic stress disorder.
    • Each person reacts differently to trauma. It is critical that service providers not judge victims based on their response to the violence (e.g., do not assume they are unaffected by the assault if they are calm and seems in control of their emotions).

Initial Response

If an individual with disabilities discloses sexual victimization, (1) gather general information from the victim about the situation, with their permission, (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. Initial response should be based on victims’ self-identified needs rather than your professional opinions and/or family members’ concerns. To the extent possible, victims should make their own choices about how to address any identified needs and concerns.

  • Convey to victims that: you believe them, the sexual assault was not their fault, and you can assist in getting help. Respect and accommodate the methods and pace of communication of each victim, their specific needs, abilities and experiences.
  • Ask victims about any safety concerns (for themselves, family, friends, service animals, etc.). Ask them to be specific. Validate their concerns. In the case of imminent danger, call 911 as per your agency’s policy.
  • Ask victims “Is there anything I should know that will enable me to better assist you?” If victims disclose having a disability, it is helpful for you to identify any concerns they have related to how the disability may affect their reactions to the assault, their safety and/or their ability to access services, as well as what accommodations would be useful. Note that it may be difficult for victims to identify if and how a disability impacts the situation (e.g., because they have not considered this issue before, have trouble comprehending the extent of the danger posed and/or are 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 diseases/infections (STD/STI) and/or pregnancy (if applicable). Help facilitate medical care for victims as per your agency’s policy. (See below for information on forensic medical examinations.)
  • 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 (see below). If a mandatory report is required, encourage victims to initiate the report themselves and offer assistance in reporting.
  • Explain the need for evidence collection if the case has/may be reported to law enforcement. 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 them during the exam, medical facility options and options for transportation to a medical facility. Encourage victims to let responders know how to best accommodate their 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 they cannot wait to urinate until arrival at the facility. Explain that since their clothing may be taken as evidence, they may wish to arrange to have a change of clothes at the medical facility. (However, note that it is common for victims to have already done some of these activities prior to the exam—e.g., they may have showered immediately after the assault. Explain to victims, if this is the situation for them, they have not “ruined” their case.)
    • 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 victim have 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.
    • See the section, Forensic Medical Exam, for more on the exam process.
  • Identify additional concerns of victims and help prioritize them. For example, they may have questions and concerns about whether what happened to them 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 focusing on immediate options.
  • Ask victims if you can help them develop a plan to address their immediate safety needs (for them and their dependents, pets and service animals as applicable to the situation). The plan should identify specific tasks, persons and resources that can help meet their needs. These could include:
    • Specific steps that victims can take to address immediate safety concerns. Offer assistance in brainstorming creative solutions to safety that are within her abilities and resources. (Hoog, 2003).
    • Supportive persons whom victims 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 victims have to flee from their 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 victims’ urgent needs. As appropriate, ask if you can immediately connect them with agencies to help them cope with the situation (e.g., to the local rape crisis center).
  • Encourage victims to follow up to let you know how they are doing and to develop a longer-term plan for safety and other assistance.

Mandatory Reporting Situations

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 for mandatory reporting:

  • In West Virginia, mandatory reporters of suspected abuse or neglect of adults who are vulnerable, or of emergent situations where adults who are vulnerable 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 (WVC §9-6-9). Check with your supervisor to if you are unsure if you are a mandatory reporter.
    • An adult who is considered “vulnerable,” according to State law, is any person over the age of 18, or an emancipated minor, who by reason of physical or mental condition is unable to independently carry on the daily activities of life necessary to sustaining life and reasonable health and protection (WVC §9-6-1). Abuse, neglect or an emergent situation involving an adult who is vulnerable should be reported to the Department of Health and Human Resources’ (DHHR) 24-hour abuse and neglect hotline (800-352-6513). The initial phone report shall be followed by a written report by the complainant or the receiving agency within 48 hours. (WVC §9-6-11).
  • 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, school teachers and other school personnel, social service workers, 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, magistrates, youth camp administrators or counselors, employee, coach or volunteer of entities that provide organized activities for children, or commercial film or photographic print processors. (WVC §49-2-803). Check with your supervisor if you are unsure if you are a mandatory reporter.
    • Reports of suspected child abuse or neglect should be made to the DHHR 24-hour abuse and neglect hotline (800-352-6513). Reports should be made immediately to DHHR (and not more than 24 hours after suspecting the abuse or neglect), followed by a written report within 48 hours, if requested by the receiving agency. In any case where the reporter believes that the child suffered serious physical abuse or sexual abuse or sexual assault, the reporter shall also immediately report to the State Police and any law-enforcement agency having jurisdiction to investigate the complaint.  Reporter from public or private institutions, schools, entities that provides organized activities for children, facilities or agencies shall also immediately notify the person in charge, who may supplement the report or cause an additional report to be made. However, notifying a person in charge does not exempt persons from their own mandated reporting responsibilities. (WVC §49-2-803, §49-2-809).

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 vulnerable 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 (WVC §49-4-115). 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.

Protective Strategies

Individuals are never be blamed or held responsible for their own victimization. However, increasing protective strategies for at-risk individuals is 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 appropriate to a person’s needs/capacities (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
  • Maintain regular conversations with someone other than a caregiver to verify personal safety
  • Have an individualized safety plan and update it as needed (if your situation changes)

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

Related Considerations

Communications

General considerations when communicating with persons with disabilities include (Adapted from Adaptive Environments Center, Inc., 1992; Ward & Associates, 1994):

  • 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 they prefer 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 they need 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 directions given. 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, an individual who is upset 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 experienced to become familiar with the person’s 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 their 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 being communicated to you. Ask if there is anything you can do to make the interaction better (Day One et al., 2004).

It is helpful to determine the relationship between suspected perpetrators and their victims. If perpetrators are their victims’ caregiver or a family member, you will need to know what the relationship means to each 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 losing the caregiver and being forced into an assisted living situation?

Accommodations

Accommodations are often essential to allow sexual assault victims 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 (Americans with Disabilities Act) to describe a wide range of services and devices that promote effective communication.
  • 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 victims with disabilities what they need to access services. What is effective for one could be ineffective for another. 

Self-Advocacy

If a person with a disability is a victim of sexual violence, self-advocacy can be critical to 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 individuals to build their self-advocacy skills. Because victimization often involves the sense of a loss of power, supporting victims in their actions, rather than acting on their behalf, helps them regain control. 

Factors that can prevent a person from obtaining skills that promote self-advocacy include (Johnson, 1999): 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 (Mitchell, 1988); 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 persons with a disability to overcome these barriers and become a self-advocate is self-awareness—knowing their strengths and challenges and how their disability affects both them and how they interact with others. 

The “dignity of risk” means respecting an individuals’ choices, as long as their actions are not harmful to themselves or others (Day One et al., 2004). Not allowing individuals to take risks means denying a basic educational tool in life—learning from experience and using that knowledge in future opportunities.  

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 (with exceptions). 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 meets the definition as a protected person; the suitability of the proposed guardian/conservator; the person’s limitations; the development of the person’s maximum self-reliance and independence; the availability of less restrictive alternatives. If considered a protected person, the court selects the guardian/conservator to be appointed and issues an order of appointment that signifies the type of guardian/conservator and specific areas of protection, management and assistance to be granted, 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. (For more details, see WV Department of Health and Human Resources, Social Services Manual, Guardianship Policy.)
  • 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 DHHR statewide abuse and neglect 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.

Resources

Sexual Violence and Persons with Disabilities Brochure
Serving Sexual Violence Victims with Disabilities Brochure
    References

    Americans with Disabilities Act. Title II technical assistance manual II-7.1000. Washington, DC: U.S. Department of Justice.

    Baladerian, N. (1985). Survivor, book III. For family members, advocates and care-providers. Palm Springs, CA: Author.

    Brunnberg, E., Boström, M.L. & Berglund, M. (2012). Sexual force at sexual debut. Swedish adolescents with disabilities at higher risk than adolescents without disabilities. Child Abuse & Neglect, 36, 285-295.

    Casteel, C., Martin, S.L., Smith, J.B., Gurka, K.K. & Kupper, L.L. (2008). National study of physical and sexual assault among women with disabilities. Injury Prevention, 14, 87-90.

    Cantor, D., Fisher, B., Chibnall, S., Harps, S., Townsend, R., Thomas, G., Lee, H., Kranz, V., Herbison, R. & Madden, K. (2019, revised 2020). Report on the AAU campus climate survey on sexual assault and sexual misconduct. Washington, DC: Association of American Universities.

    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. (2004). Is your agency prepared to ACT? Conversation modules to explore the intersection of violence and disability. Advocacy Collaboration Training Initiative.

    Erickson, W., Lee, C. & von Schrader, S. (2017). Disability statistics from the American community survey. Ithaca, NY: Cornell University Yang-Tan Institute.

    Harrell, E.  (2021).  Crime against persons with disabilities, 2009-2019 – Statistical tables.  Washington, DC: U.S.  Department of Justice, Office of Justice Programs, Bureau of Justice Statistics.

    Hoog, C. (2003). Enough and yet not enough: An educational resource manual on domestic violence advocacy for persons with disabilities in Washington state. Olympia, WA: Washington State Coalition Against Domestic Violence,

    Johnson, J. (1999). Leadership and self-determination. Focus on Autism and Other Developmental Disabilities, 14(1), 4-16.

    Lund, E., & Vaughn-Jensen, J. (2012). Victimization of children with disabilities. Lancet, 380(9845), 867–869.

    Massachusetts District Attorneys Association. (2006). Building partnerships for the protection of persons with disabilities, Protect, report, preserve: Abuse against persons with disabilities. Boston, MA: Author.

    Mitchell, B. (1988). Who chooses?, National Dissemination Center for Children and Disabilities transition summary.

    Smith, N., & Harrell, S. (2013). Sexual abuse of children with disabilities: A national snapshot. New York, NY: Vera Institute of Justice, Center on Victimization and Safety.

    Smith, N., Harrell, S., Smith, J & Demyan, A. (2015). Measuring capacity to serve domestic violence and sexual assault survivors with disabilities: New York, NY: Vera Institute of Justice.

    Ticoll, M. (1994). Violence and people with disabilities: A review of the literature. Ontario, Canada: Roeher Institute.

    Ward, I.M. & Associates. (1994). Ten commandments of communicating with people with disabilities [Video & written material]. Columbus, OH: Author.

    West Virginia Bureau for Public Health, Health Statistics Center. (2008). Behavioral risk factor surveillance system survey. Charleston, WV: Department of Health and Human Resources.

    Wisconsin Coalition Against Sexual Assault. (2001). Transcending silence: A series about speaking out and taking action in our communities. Madison, WI: Author.

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