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D.A.R.T. Alaska
A Collaborative Approach to Addressing
Violence and Abuse of People with
Disabilities
Presenter:
Leslie Myers, MS, CRC, CDVC
Domestic Violence Specialist and Counselor
600 W Virginia Street
Milwaukee, WI 53204
(414) 226-8381 (V/Relay)
(414) 291-7520 (V/TTY)
[email protected]
www.independencefirst.org
DISABILITY 101
US Disability Demographics
300,000,000
250,000,000
Total Population
200,000,000
150,000,000
Disability status
(population 5 years and
over)
100,000,000
50,000,000
0
257,167,527
49,746,248
Alaska Disability Demographics
600,000
500,000
400,000
300,000
200,000
100,000
0
585,263
Alaska Population
88,000
Persons with Disabilities
Brain, Cognitive and
Developmental Disabilities
There are a variety of disabilities that affect the brain, including:
Alzheimer's Disease, a progressive disability that gradually
destroys a person's memory and ability to learn and carry out
daily activities such as talking, eating, and going to the bathroom.
Stroke, also known as cerebrovascular accident (CVA),is an
acute neurological injury in which the blood supply to a part of the
brain is interrupted.
Huntington's Disease (Huntington's chorea) is a progressive,
degenerative disease that causes certain nerve cells in the brain to
waste away, resulting in uncontrolled movements, emotional
disturbances and mental deterioration.
Epilepsy is a brain disorder in which, the normal pattern of neuronal
activity becomes disturbed, causing strange sensations, emotions, and
behavior or sometimes convulsions, muscle spasms, and loss of
consciousness.
Parkinson's Disease causes tremors, stiffness of the limbs and trunk,
slowness of movement and impaired balance and coordination, making
it difficult to walk, talk, or complete other simple tasks.
ALS (Lou Gehrig's Disease) is a rapidly progressive neurological
disease, that is always fatal. It attacks the nerve cells (neurons)
responsible for controlling voluntary muscles, causing the loss of the
ability to move arms, legs and body.
Multiple Sclerosis is an unpredictable disease of the central nervous
system, that can range from relatively benign to somewhat disabling
to devastating, as communication between the brain and other parts
of the body is disrupted.
Cerebral Palsy is caused by abnormalities in parts of the brain that
control muscle movements and appears in infancy or early childhood
and permanently affects body movement and muscle coordination.
Muscular Dystrophy are a group of more than 30 diseases
characterized by progressive weakness and degeneration of the
skeletal muscles that control movement.
Some of these disabilities impact the person’s cognitive ability while
others do not.
The concept of cognitive disabilities is extremely broad,
and not always well-defined. In general a person with a
cognitive disability has greater difficulty with one or
more types of mental tasks than the average person.
Some of the main categories of functional cognitive disabilities
include deficits or difficulties with:
•
Memory
•
Problem-solving
•
Attention
•
Reading, linguistic, and verbal comprehension
•
Math comprehension
•
Visual comprehension
The head is a primary target in domestic
violence. The effect of this battering can
results in a cumulative brain injury.
We can expect to find numerous
symptoms of multiple brain injuries in
women escaping from an abusive
relationship.
Besides an actual injury to the brain,
alterations in the brain can be caused by
shock and trauma of witnessing violence,
for both women and children.
Domestic Violence and Head
Injuries
Types of Brain Injuries
Diffuse Axonal Injury- occurs when the
head is shook or rotated causing the brain
structures to tear. This disrupts the brain’s
regular communication and chemical
processes and produces temporary or
permanent brain damage, coma, or death.
Concussion occurs when the brain receives trauma from
an impact or a sudden momentum or movement change. A
person may or may not experience a brief loss of
consciousness. A concussion can cause diffuse axonal
type injury resulting in permanent or temporary damage.
Types of Brain Injuries
Contusion (a bruise or bleeding) on the brain occurs from a
direct impact to the head.
Coup-Contrecoup Injury occurs when
the head is hit with such great force that
it causes a contusion at the site of
impact, and then slams the brain to the
opposite side of the skull, causing an
additional contusion.
Types of Brain Injuries
Second Impact Syndrome-("recurrent traumatic brain
injury“) occurs when a person sustains a second
traumatic brain injury before the symptoms of the first
traumatic brain injury have healed, causing brain swelling
and widespread damage.
Penetration Injury- occurs when a bullet, knife or other
sharp object forces hair, skin, bone and fragments from
the object into the brain.
Shaken Baby Syndrome occurs when a baby or young
child is aggressively shaken, causing the brain to be
injured.
Developmental Disability
The definition of a developmental disability is “a chronic disability from a
mental and/or physical impairment that manifests before the person
reaches age 22. The disability continues indefinitely and results in
substantial functional limitations in three or more areas of major life
activity”. Major life activities include: • capacity for independent living
• economic self-sufficiency
• learning
• mobility
• receptive and expressive language
• self-care
• self-direction
Mental Retardation
Mental Retardation manifests before age 18 and is characterized by
significantly sub average intellectual functioning, concurrent with related
limitations in two or more of the following applicable adaptive skill areas:
•Communication
•Self-care
•Home living
•Social skills
•Community use
•Self-direction
•Health and safety
•Functional academics
•Leisure
•Work
Classification
Additional Developmental
Disabilities
1) Pervasive Developmental Disabilities (Autism,
Asperger’s, etc.
2) Learning Disabilities (Attention Deficit Hyperactivity
Disorder, Dyslexia)
3) Cerebral Palsy
4) Fetal Alcohol Syndrome
5) Down’s Syndrome
6) Spina Bifida
Physical
Disabilities
Physical disabilities include
orthopedic, neuromuscular,
cardiovascular and pulmonary
disorders.
Physical Disabilities can be:
Congenital/Hereditary: A congenital/hereditary disability is a
disability that have been their since birth or developed later due
to genetic problems, problems with muscle cells or injury during
birth.
Acquired: An acquired disability is one that occurs as a result
of a road or industrial accidents, crime, infections such as polio
or diseases and disorders such as stroke or cancer
Orthopedic Disabilities
9A congenital anomaly (e.g., scoliosis, Spina Bifida)
9Disease, (e.g., Muscular Dystrophy, Arthritis)
9Trauma or accident (e.g., amputation)
Orthopedic Disabilities or Musculoskeletal Disabilities
are disabilities related to the musculoskeletal system; the
bones, joints and muscles. These disabilities can be the
result of:
Neurological Disabilities
Neurological disabilities involve the nervous system
affecting the ability to move, use or control certain parts of
the body. Such impairments can be the result of:
™A congenital anomaly (e.g., Cerebral Palsy)
™Disease (e.g., poliomyelitis, carpal tunnel syndrome)
™Trauma or accident (e.g., spinal cord injury, head trauma).
Violence and Physical Disabilities
Physical Disabilities can occur as a result of
violence, some of these may be temporary, i. e.
broken bones. Other injuries may result in
permanent disabilities like spinal cord injury
from the battery or from gun shots or
amputations from an injury.
Mental Illness
Does it look something like
this?
When you hear the words “mental illness” or “psychiatric
disability”…what image comes to your mind?
What is Mental Illness?
Mental illness is an illness that affects or is manifested
in a person's brain. It may impact the way a person
thinks, behaves and interacts with other people.
The term "mental illness" encompasses numerous
psychiatric disorders and just like illnesses that affect
other parts of the body, they can vary in severity.
Many people suffering from mental illness may not
look as though they are ill or that something is wrong,
while others may appear to be confused, agitated, or
withdrawn.
Stigma of Mental Illness
In our society mental illness carries a substantial stigma.
People with mental illnesses are blamed for bringing on
their own illnesses or seen as victims of bad fate, religious
and moral transgression, or witchcraft. This stigma keeps
families and individuals from acknowledging that a family
member is ill. Some may hide or overprotect the person
with a mental illness, which keeps them from receiving
potentially effective care. Others may reject the person
from the family.
When these attitudes are magnified to a whole society it
leads to underfunding of mental health services and
inadequate care.
The Experience of Mental
Illness
People with psychiatric disabilities are the only Americans
who can have their freedom taken away and be
institutionalized or incarcerated without being convicted of a
crime and with minimal or no respect for their due process
rights. They are the only Americans who can routinely be
forced to submit to medical treatments against their will.
When people with psychiatric disabilities die in facilities that
are supposed to serve and protect them, their deaths are
rarely investigated, and even when they are, criminal
charges are rarely filed.
Degradation
Neglect
Overcrowding
Extermination
People with mental illnesses were
the first victims to be exterminated in
Nazi Germany. In 1939 German
psychiatric hospitals held between
300,000 and 320,00 patients. Only
40,000 were still alive after the war.
In 1941, the Hadamar psychiatric
institution celebrated the cremation of
its ten thousandth "mental patient."
Death
Between 1950 and 1964, more people
died in United States federal, state and
county 'mental institutions' than the
number of Americans killed in the
Revolutionary War, the War of 1812, the
Mexican War, the Civil War, the SpanishAmerican War, World War I, World War II,
the Korean War, Vietnam, and the Persian
Gulf War…………………….
Combined!
Prevalence of Mental Illness
Domestic Violence and Mental
Illness
There are many psychological effects of domestic violence:
¾
60% of battered women report depression
¾
Battered women are at greater risk for suicide
attempts, with 25% of suicide attempts by Caucasian
women and 50% of suicide attempts by African
American women preceded by abuse.
¾
Posttraumatic Stress Disorder (PTSD) is another
common effect and it is characterized by symptoms
such as flashbacks, intrusive imagery, nightmares,
anxiety, emotional numbing, insomnia, hypervigilance, and avoidance of traumatic triggers.
Psychiatric Disabilities
Anxiety disorders involve excessive apprehension,
worry, and fear. Includes generalized anxiety disorder,
phobias, panic disorder, obsessive-compulsive disorder,
and post-traumatic stress disorder.
Mood disorders, also called affective
disorders, create disturbances in a person’s
emotional life, includes depression, mania and
bipolar disorder.
Psychiatric Disabilities
Schizophrenia and other psychotic disorders
cause a person to lose contact with reality and
may include delusions and hallucinations,
disorganized thinking and speech, bizarre
behavior, and social withdrawal.
Personality disorders are mental illnesses
in which one’s personality results in
personal distress or a significant
impairment in social or work functioning.
Psychiatric Disabilities
Cognitive disorders, such as delirium and dementia,
involve a significant loss of mental functioning.
Dissociative disorders involve disturbances
in a person’s consciousness, memories,
identity, and perception of the environment.
Includes amnesia, dissociative identity
disorder, depersonalization disorder, and
dissociative fugue.
Somatoform disorders are characterized by the presence
of physical symptoms that cannot be explained by a medical
condition or another mental illness. Includes conversion
disorder and hypochondriasis.
Psychiatric Disabilities
Factitious disorders, people intentionally produce or
fake physical or psychological symptoms in order to
receive medical attention and care. For example
Munchausen Syndrome.
Substance-related disorders result
from the abuse of drugs, side effects of
medications, or exposure to toxic
substances. Includes alcoholism and
other forms of drug dependence, like
caffeine, nicotine, cocaine, heroin,
amphetamines, hallucinogens and
sedatives.
Psychiatric Disabilities
Eating disorders are conditions in which an individual
experiences severe disturbances in eating behaviors.
Includes anorexia nervosa and bulimia nervosa.
Impulse-control disorders cause
an inability to control an impulse to
engage in harmful behaviors, such
as explosive anger, stealing
(kleptomania), setting fires
(pyromania), gambling or pulling out
their own hair (trichotillomania).
Sensory and Communication
Disabilities
Low Vision
There are two general classifications of low vision:
Partially sighted visual acuity that with conventional
prescription lenses is still between 20/70 and 20/200
Legal blindness visual acuity that cannot be corrected to
better than 20/200 with conventional lenses and/or the
patient has a restricted field of vision less than 20 degrees
wide, 90% of people who are legally blind have some
remaining vision.
Normal Vision 20/20
Vision
Glaucoma
Cataract
Diabetic Retinopathy
Vision
Macular Degeneration
Myopia (nearsightedness)
Retinitis pigmentosa (RP)
Hearing Loss and Deafness
Conductive hearing loss is caused by the failure of the three
tiny bones inside the middle ear to pass along sound waves to
the inner ear or the failure of the eardrum to vibrate in
response to sound waves.
Sensorineural hearing loss results from malfunction of inner
ear structures (i.e., cochlea) due to disease, trauma or some
other disruptive event targeting the cochlear nerve.
Mixed hearing loss is a combination of conductive
and sensorineural hearing loss.
Central auditory dysfunction results from damage
or dysfunction at the level of the 8th cranial nerve,
auditory brain stem, or cerebral cortex.
Prelingual hearing loss is present before speech
develops.
Postlingual hearing loss occurs after the development
of normal speech.
Causes of hearing loss and deafness include:
9
Hereditary, in most cases, hereditary deafness is caused by
malformations of the inner ear.
9
Genetics, includes osteogenesis imperfecta and multiple lentigines
syndrome.
9
Prenatal exposure to disease, including rubella (German measles),
influenza and mumps.
9
Noise
9
Trauma
9
Diseases, like meningitis, mumps, cytomegalovirus and chicken pox.
9
Meniere's disease
9
Exposure to certain chemicals.
9
Age
Deaf vs. deaf
Deaf with a lowercase-d is generally understood to mean a physical loss
of hearing. This use of the word “deaf” refers to the millions of people
who suffer some degree of hearing loss due to age. Despite this loss of
hearing, whether it is a mild reduction or a complete loss, these
individuals are not members of the Deaf Community.
Capital-d Deaf is a term that is applied to those individuals who lose
their hearing at a young age. These individuals grow up NOT in the
hearing world, but as members of the Deaf Community. Linguistically,
the Deaf are a separate community from the hearing world. The Deaf
Community's primary language is American Sign Language. This
distinction may seem minor, but it underlies the foundation of Deaf
Culture. The Deaf Community has its own social structures, art, clubs
and organizations, values and cultural history.
Speech Disabilities
Fluency disorder: an interruption in the flow or rhythm of
speech characterized by hesitations, repetitions or
prolongations of nouns, syllables, words or phrases.
Articulation disorder: difficulties with the way sounds are
formed and strung together, characterized by substituting
one sound for another (wabbit for rabbit), omitting a sound
(han for hand) and distorting a sound (shlip for sip).
Voice disorder: characterized by inappropriate pitch (too
high, too low never changing or interrupted by breaks; quality
(harsh, hoarse, breathy or nasal); loudness, resonance, and
duration.
Speech Disabilities
Aphasia the loss of speech and language abilities generally
resulting from stroke.
Apraxia of speech, is a speech disorder in which a person
has trouble saying what he or she wants to say correctly and
consistently.
Delayed language characterized by a marked slowness in
the development of language skills necessary for expressing
and understanding thoughts and ideas.