Karen Rogers: Abuse Risk Reduction Skills for Children with Developmental Disabilities: Making Friends and Staying Safe - Slide presentation

1. Abuse Risk Reduction Skills for Children
with Developmental Disabilities: Making
Friends and Staying Safe
Karen C. Rogers, Ph.D.
Project HEAL Trauma Program
USC University Center for Excellence in Developmental Disabilities
Children’s Hospital Los Angeles, USA

2. OBJECTIVES
 Briefly review abuse risk factors among children with
developmental disabilities and their caregivers
 Introduce an abuse risk reduction program, Making
Friends and Staying Safe group program

3. How often are persons with
developmental disabilities
abused?
 Individuals with developmental disabilities are at
increased risk for abuse as compared to the general
population (Gil, 1970; Mahoney & Carrillo, 1998; Ryan, 1994).
 80% of mentally handicapped persons living in the
community are physically and sexually abused, cheated,
and robbed (Melberg, 1984).
 Nearly a quarter of a million Californians are victims of
elder and dependent adult abuse very year (National Aging
Resource Center on Elder Abuse, 1999)
 Some estimates suggest as many as 1/3 of children in
foster care have a developmental disability (American
Academy of Pediatrics, 2002)

4. How often are children with
developmental disabilities
sexually abused?
 1.8 times higher risk among those with
disabilities (Crosse, Kaye & Ratnofsky, 1993).
 Girls are at greater risk for being sexually
abused than boys (Sobsey, 1994).
 39%-83% of girls and 16%-32% of boys by age 18
vs. 20-30% & 10-15% (Badgley, 1984 & Hard, 1986 in
Baladerian, 1991 vs. Finkelhor et al, 1989).
 Most children identified as victims of abuse are
simultaneously subjected to more than one
type of maltreatment (Verdugo, 1995).

5. Characteristics of Abuse
 Abuse often chronic and severe, with
revictimization by the same person.
 Abuse may occur over many years with multiple
perpetrators.
 In 44% of the cases the offenders had a
relationship with the victim related to the
victim’s disability.
 Children who were less obviously disabled were
at greater risk.
 However children with severe language
problems are easy targets for abuse possibly
because they can’t “tell”

6. RISK FACTORS FOR ABUSE IN CHILDREN
WITH DD (Sobesy, 2002)
 Factors associated with the child
 Factors associated with the
perpetrator
 Environmental/familial factors

7. RISK FACTORS ASSOCIATED
WITH THE CHILD
 Impaired communication
 Cognitive impairments
 Lack of body knowledge
 Limited mobility
 Social isolation, distancing
 Low self-esteem
 Increased dependence
 Reinforced to be compliant

8. RISK FACTORS ASSOCIATED
WITH THE PERPETRATOR
 Large number of caregivers
 Scarce training
 Seeking employment in disability
related services
 Trusted by family members and
other caregivers

9. FAMILIAL & ENVIRONMENTAL
FACTORS
 Social isolation
 Myths about people with developmental disabilities
 Increased caregiver stress
 More likely to be in out-of-home placement
 Cultural attitudes & beliefs
• “No one would abuse a person with a disability”
• “Children with a disability are safe because they are
always with trusted people”
• “People with a disability don’t understand what is
happening, so they don’t suffer the way other youth do”
• “Keeping children at home or in a sheltered group facility
will lessen the risk of abuse”

10. A GROUP THERAPY APPROACH:
“Making Friends & Staying Safe”

11. MAKING FRIENDS & STAYING SAFE
A Social Skills Development
and Abuse Prevention Group
 Housed under the Project Heal Trauma Program
 Children’s Hospital Los Angeles/University of Southern
California /University Center for Excellence in
Developmental Disabilities
 16 weeks
 60 minutes sessions
 Co-concurring children and caregiver(s)
groups
 Caregiver group offered in English or Spanish

12. BENEFITS OF GROUP INTERVENTION
 Reduces social isolation among children and caregivers
 Provides opportunity for children to practice new skills
 Desensitizes participants to talking about sexual
education topics
 Normalizes content within
developmental context
 Cost effective

13. KEY GROUP ADAPTATIONS
 Shorter length of sessions
 Low client to therapist ratio (3:1)
 Visual alternatives for all verbal materials
 Directive teaching approach
 Structured format
 Use of developmentally appropriate language
 Slower pace/comprehension checks
 Repetition, Rehearsal and Reminder phrases
 Behavioral management/positive reinforcement system

14. MFSS STRATEGIES FOR CHILDREN
 Identification & expression of feelings
 Enhancing self-esteem & social skills
 Personal boundaries and body rights
 Sexual development/sexual education
 Abuse prevention skills

15. MFSS STRATEGIES FOR PARENTS
 Empathy and respect
 Education
 Peer support
 Linkage to community resources
 Skill building strategies
 Attention to personal experiences

16. CULTURAL CONSIDERATIONS
 Culture is an important variable in determining how
individuals see/interpret the world and make decisions
(traditions, ways of living, coping behaviors, values,
norms, and beliefs).
 Value of sexual education
 Stigma towards disability
 Beliefs regarding cause of
developmental disability
 Access to appropriate services

17. REFERENCES
 Batshaw, M., Pellegrino, L., & Roizen, N. (2009). Children with
Disabilities (6th ed.).Baltimore: Paul H. Brooks.
 California State Council on Developmental Disabilities.
http://www.scdd.ca.gov/Developmental_Disabilities.htm
 California Child Abuse Training and Technical Assistance Centers
(n.d.). Children with Disabilities & Sexual Abuse Fact Sheet.
Retrieved March 2012 from http://cirinc.org/catta/wp-
content/plugins/downloads-manager/upload/FactSheet.pdf
 Child Welfare Information Gateway (2009). The Risk and Prevention
of Maltreatment of Children with Disabilities. Washington, DC:U.S.
Department of Health and Human Services. Retrieved March 2012
from http://www.childwelfare.gov/pubs/prevenres
/focus/focusa.cfm

18.  Child Welfare Information Gateway (2009). Understanding the
Effects of Maltreatment on Brain Development. Washington,
DC:U.S. Department of Health and Human Services. Retrieved March
2012 from http://www.childwelfare.gov/pubs/issue_briefs/
braindevelopment/effects.cfm
 Comisión Nacional de los Derechos Humanos (2011). Niños, Niñas y
Adolescentes Victimas de la Violencia y del Delito. Mexico, D.F.
Retrieved November 2012 from http://www.cndh.org.mx/sites/all/
fuentes/documentos/Programas/Provictima/5%20PUBLICACIONES/2J
ORNADAS/DECIMAS_JORNADAS.pdf
 Cook, A., Blaustein, M., Spinazolla, J., van der Kolk, B. (2003)
Complex trauma in children and adolescents. White paper from the
national child traumatic stress network complex trauma task force.
Los Angeles, CA: National Center for Child Traumatic Stress.

19.  Cook, A., Spinazzola, J., Ford, J., Lanktree, C., et. al. (2005)
Complex trauma in children and adolescents. Psychiatric Annals,
35:5, 390-398.
 LeDoux J.E. (1993). Emotional memory systems in the brain. Behav.
Brain Res. 58:69-79.
 Secretaria de Salud (2006). Informed Nacional sobre Violencia y
Salud. Mexico,D.F. Retrieved November 2012 from
http://www.unicef.org/mexico/spanish/Informe_Nacional-
capitulo_II_y_III%281%29.pdf
 Sobsey, D. (2002). Exceptionality, education and maltreatment.
Exceptionality, 10(1), 29-46.
 Turner, H., Vanderminden, J., Finkelhor, D., Hamby, S., & Shattuck,
A.(2011). Disability and Victimization in a National Sample of Children
and Youth. Child Maltreatment, 16(4), 275-286.

20.  U.S. Department of Health and Human Services, Administration for
Children and Families, Administration on Children, Youth and
Families, Children’s Bureau(2011). Child Maltreatment 2010.
Retrieved March 2012 from http://www.acf.hhs.gov/programs/
cb/pubs/cm10/cm10.pdf#page=63
 World Health Organization (1999)Report of the Consultation on Child
Abuse Prevention, Social Change and Mental Health, Violence and
Injury Prevention. Retrieved October 2012 from www.who.int/mip
2001/files/2017/childabuse.pdf
 World Health Organization (2012) Early Childhood Development and
Disability: A discussion paper. Retrieved October 2012 from
http://apps.who.int/iris/bitstream/10665/75355/1/9789241504065_
eng.pdf

21. QUESTIONS/COMMENTS?
THANK YOU
For further information:
Karen Rogers, Ph.D.
krogers@chla.usc.edu