disability case study examples pdf

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Case Report: A Case of Intellectual Disability with Inappropriate and Challenging Sexual Behavior that was Treated with GNRH Analogues

Intellectual Disability starts within the course of developmental stages and covers both intellectual and adaptive deficiencies in conceptual, social and applied fields. Individuals with intellectual disability experience many difficulties in social life due to challenging and inappropriate sexual behaviour. Suchdifficulties need to be addressed, reduced or treated. Traditional treatments often fail to treat and improve suchbehavior. Alternative treatment options need to be explored with studies conducted in this field. With this paper, we aimed to show and touch on alternative treatments for challenging and inappropriate behaviors of a 15-year old boy with intellectual disability, who was treated with GNRH analogues.

Introduction

Intellectual Disability is defined in DSM-5 as a conceptual, socially defective disorder that covers both intellectual and adaptive deficiencies and starts during the developmental stage. 1 Aggressive and challenging behaviors are frequently seen in these individuals with limited coping skills. 2 These behaviors, which are considered as the most important factors in applying to psychiatry clinics and drug use, make it difficult for caregivers that provide care to and live with intellectually disabled individuals. 3 , 4 Individuals with intellectual disabilities may have difficulty interpreting behavioral cues within their social environment. That is an obstacle for them to express their sexual desire in socially acceptable ways. 5 However; aggressive and challenging behaviors as well as inappropriate behaviors can be seen frequently in these individuals. These inappropriate behavior might be listed as masturbation, genital exposure, inappropriate sexual touching and embracing others too close. 6 – 8 Challenging and inappropriate sexual behaviors in individuals with intellectual disability are significant problems that need to be addressed in clinical practice. Antipsychotics are frequently used in clinical practice to manage these behaviors. However, there is a discrepancy regarding reports of the efficiency of antipsychotics medication in studies conducted in this field. 9 , 10 So, these drugs may not be efficient in the management of such behavior in certain individuals with intellectual disability. Despite ethical concerns, drugs that reduce sexual desire are sometimes used to reduce inappropriate sexual behavior. There are case reports that report GnRH analogues might be beneficial in cases with inappropriate sexual behavior and aggression in individuals with autism. 11 – 14 The use of GnRH analogues has several risks including delayed pubertal development, decreased muscle mass and bone density. In this case report, we aimed to discuss the use and efficacy of leuprolide as a GnRH analogue in a patient diagnosed with Intellectual Disability with challenging and inappropriate sexual behaviors that could not be suppressed by antipsychotics or other drugs.

A 15-year-old boy was brought to our child psychiatry clinic due to his aggressive and inappropriate sexual behaviors such as completely stripping off his clothes, and inappropriately touching private parts of the individuals in the household and others. It was noted that the patient had difficulties in speaking and language skills, interpersonal relations, academic and self-care skills as a result of the psychiatric examination. It was learned from the medical history that he was diagnosed with intellectual disability at primary school and he attended a special education center and a school where individuals with special needs went. He was asked to perform Wechsler Intelligence Scale for Children-Revised (WISC-R), bu he could not cooperate. According to the clinical opinion and history of the clinician and psychologist, he was diagnosed with moderate intellectual disability. There was no comorbid psychiatric diagnosis in psychiatric examination and history. It was learned from his parents that aggressive and inappropriate sexual behavior started in adolescence and has been on the increase for the past year. Also, It was learned that despite behavioral interventions and psychopharmacological treatments recommended by child psychiatrists they have met so far, no improvement was observed. Hormonal therapy was planned because the aggressive and inappropriate sexual behaviors persisted against all treatment interventions, it was noted that these behaviors made it difficult to live with the patient. The family was informed about the hormone treatment and associated effects and side effects. The patient was referred to a pediatric clinic for endocrinological and neurological examination. As a result of the physical examination; he was diagnosed with obesity (BMI: 36,26). Total testosterone level was 225 ng/dl. The diagnosis of Prader Willi Syndrome was excluded via genetic analysis. Consequently; it was concluded that GNRH analogue might be a treatment option. This alternative treatment option was used for reducing inappropriate and challenging sexual behavior despite ethical concerns, according to previous case reports. 11 – 14

Parents wereinformed about the uncertainties including costs, treatment expectations and possible side effects related to off-label use and written consent was obtained from the parents. 3.75 mg leuprolide acetate was administered intramuscularly once in every 28 days. No other psychotropic drug was used simultaneously. The patient was examined once a month for possible side effects and puberty evaluation. Strength and Difficulties Questionnaire (SDQ) and Turkish version of Aberrant Behavior Checklist (ABC) were completed by parents at the onset of treatment and every following month. It was learned that the boy’s challenging and inappropriate sexual behaviors increased after the first and second doses of leuprolide. There were no decrease in SDQ ve ABC scores. Parents’ anxiety gradually increased due to worsening of the symptoms. After the third dose, he was admitted to the psychiatry inpatient unit for observation. No other medication was prescribed, other than lorazepam that was to be used whenever required. During his 2-week inpatient stay, his challenging and inappropriate sexual behaviors increased gradually. Therefore leuprolide treatment was stopped. Testoterone level was 270 ng/dl after the third dose. SDQ and ABC scores were presented in Table1 .

Challenging and inappropriate sexual behaviors in adolescents with intellectual disability may cause significant concerns for others and restrictions for the individual. There may also be more serious negative consequences for these individuals, such as forensic events. Despite ethical concerns, hormonal treatment options are sometimes considered especially in the management of inappropriate sexual behaviors.

Although there is limited literature on the use of GnRH analogue in management of challenging and inappropriate sexual behaviors, results from individuals diagnosed with autism spectrum disorder promise that this treatment option might be beneficial. 11 – 14 In some case reports; GnRH analogue therapy has been reported to reduce inappropriate sexual behavior. 11 , 13 , 14 Robin et al. (2016) reported that GnRH analogues were effective in managing such behavior in a male patient with autism, who had severe aggressive behavior since the onset of puberty. 12 A positive effect of combined long acting GNRH agonist treatment and heavy metal chelation therapy on aggressive behavior has been reported in 11 autistic children. 15 , 16 Based on these previously reported clinical experiences, we decided to use a GnRH analogue to manage and reduce challenging and inappropriate sexual behavior in this patient with Intellectual Disability. Another reason for this decision was that these problems did not decrease with behavioral methods, education and commonly used pharmacological drugs. 3.75 mg leuprolide acetate was administered intramuscularly and 3 doses every 28 days. Our aim was to reduce gonodal steroid levels to pre-pubertal levels. However, during the follow-up, we observed that the patient could not tolerate the treatment and there was an increase in both challenging and inappropriate sexual behaviors. There were no changes in SDQ scores and increases in ABC scores. Therefore, treatment with leuprolide acetate was stopped.

It is known that administration of leuprolide acetate in humans initially causes a temporary increase in gonadal steroid levels (testosterone and dihydrotestosterone in men). A mild increase in testosterone levels was observed in our patient after the administration of leuprolide acetate. Although there was a mild increase in testosterone levels, we thought there might be a difference in testosterone receptor sensitivity. The negative outcome of treatment in this case is different from the positive experiences mentioned in the literature. It should be noted that GnRH analogue therapy might not be beneficial and efficient in all patients. We believe that this case report will make a significant contribution to the limited literature on the use of GnRH analogues in challenging and inappropriate sexual behavior.

• © 2021

Disability as Diversity

A Case Studies Companion Guide

• Leslie Neal-Boylan 0 ,
• Lisa M. Meeks   ORCID: https://orcid.org/0000-0002-3647-3657 1

Mansfield Kaseman Health Clinic, Chevy Chase, Rockville, USA

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Department of Family Medicine, University of Michigan Medical School, Ann Arbor, USA

• The information is critically needed, as this is a first-of-its kind publication
• Case studies are connected to case law and OCR decisions for health science programs
• Applicable across healthcare professions

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Table of contents (15 chapters)

Front matter, medical student cases, the student with a learning disability: clarissa connors, a medical student with undiagnosed adhd and a learning disability.

• Kristina H. Petersen, Stacy C. Jones, Lisa M. Meeks

The Student with a Physical Disability: Tammy Thomas, a Clinical Year Medical Student with Quadriplegia

• Christopher D. Connolly, Maya M. Hammoud, Charlotte H. O’Connor

The Student with a Sensory Disability: Conrad Barker, a Rising Third-Year Medical Student with Hearing Loss

• Michael S. Argenyi, Alicia Booth, Christine Low

The Student with a Psychological Disability: Rhonda Rapp, a Fourth-Year Medical Student with Depression and PTSD

• Lisa M. Meeks, Hilit F. Mechaber, Samantha Schroth, Rahael Gupta, Joseph F. Murray

The Student with a Chronic Health Condition: Hillary Hampton, a Second-Year Medical Student with Crohn’s Disease

• Nichole L. Taylor, Charlotte H. O’Connor

The Student with Cancer: Marc Fernandez, a Fourth-Year Medical Student with Cancer

• Nichole L. Taylor, Catherine Moore, Suzanne Hawks

Nursing Student Cases

The student with a learning disability: mee sook smith, a nursing student with a learning disability in an associate degree program.

• Leslie Neal-Boylan, Patricia Lussier-Duynstee, Christine Low

The Student with a Learning Disability: Maxwell Mason, a Nursing Student with a Learning Disability in a Baccalaureate Degree Program

• Patricia Lussier-Duynstee, Charlotte H. O’Connor, Leslie Neal-Boylan

The Student with a Physical Disability: Sam Stone, a Nursing Student with a Missing Limb

• Leslie Neal-Boylan, Patricia Lussier-Duynstee, Jan Serrantino-Cox

The Student with a Sensory Disability: Anna Howard, a Deaf Nursing Student

• Stacey M. Carroll, Carrie Morgan Eaton, Marie Lusk

The Student with a Psychological Disability: Melanie Mathews, a Nursing Student with Suicidal Ideation

• Leslie Neal-Boylan, Michelle D. Miller, Jan Serrantino-Cox

The Student with a Chronic Health Condition: Susan Nacht, a Nursing Student with Narcolepsy

• Sharron E. Guillett, Elizabeth Kane

Focused Topic Cases

The student using medical marijuana.

• Leslie Neal-Boylan, Charlotte H. O’Connor

The Student Who Brings an Animal to Class

• Patricia Lussier-Duynstee, Christine Low, Elisa P. Laird, Leslie Neal-Boylan

The Student Who Fails the Medical Board Exam

• Kristina H. Petersen, Lisa M. Meeks

Back Matter

• Case studies
• Disability services

Leslie Neal-Boylan

Lisa M. Meeks

Leslie Neal-Boylan, PhD, APRN, CRRN, FAAN

Solomont School of Nursing

University of Massachusetts

Lowell, MA, USA

[email protected]

Lisa M. Meeks, PhD, MA

Department of Family Medicine

The University of Michigan Medical School

Ann Arbor, Michigan, USA

[email protected]

Book Title : Disability as Diversity

Book Subtitle : A Case Studies Companion Guide

Editors : Leslie Neal-Boylan, Lisa M. Meeks

DOI : https://doi.org/10.1007/978-3-030-55886-4

Publisher : Springer Cham

eBook Packages : Medicine , Medicine (R0)

Copyright Information : The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2021

Softcover ISBN : 978-3-030-55885-7 Published: 01 November 2020

eBook ISBN : 978-3-030-55886-4 Published: 31 October 2020

Edition Number : 1

Number of Pages : XIV, 158

Number of Illustrations : 1 b/w illustrations, 1 illustrations in colour

Topics : Health Administration , General Practice / Family Medicine

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Search UNICEF

Case studies on disability and inclusion.

To document UNICEF’s work on disability and inclusion in Europe and Central Asia region, UNICEF Regional Office for Europe and Central Asia has developed a set of five case studies.

UNICEF takes a comprehensive approach to inclusion, working to ensure that all children have access to vital services and opportunities. When UNICEF speaks about “inclusion” this encompasses children with and without disabilities, marginalized and vulnerable children, and children from minority and hard-to-reach groups.

The case studies have a specific focus on children with disabilities and their families. However, many of the highlighted initiatives are designed for broad inclusion and benefit all children. In particular, this case study, covers such topics as: Inclusive Preschool, Assistive Technologies (AT), Early Childhood intervention (ECI), Deinstitutionalisation (DI).

Case studies

Case study 1: “Open source AAC in the ECA Region”

Files available for download (1).

Case study 2: “Inclusive Preschool in Bulgaria”

Case study 3: “Assistive technology in Armenia"

Case study 4: “Early childhood intervention in the ECA region”

Case study 5: “Deinstitutionalization in the ECA region”

Coercive Control

Case study 4: Maria

Download the whole case study as a PDF file (515KB)

Maria is 24. She had a diving accident when she was 20, and now uses a wheelchair due to a physical disability. She has a 15-month old daughter, Sophia, with her long term partner, Graham. Sophia was recently subject to a referral to children’s services, who have contacted Adult Social Care to see whether they might be able to provide support to Maria. Graham is reported to not be happy about this.

This case study considers issues around survivors with physical disabilities; multiagency working, adult safeguarding and child protection; and support to EU migrants.

When you have looked at the materials for the case study and considered these topics, you can use the critical reflection tool and the action planning tool to consider your own practice.

Case details

Download the case details as a PDF file (211KB)

Maria, 24, lives with her 15 month old daughter, Sophia, and Sophia’s biological father, Graham (34). Maria came to live in London from Greece at the age of 18. Maria’s teenage years were difficult as her father was emotionally and physically abusive towards her and her mother. Maria took a business studies course and was involved in the University Diving club. She met Graham at the club and they have been together ever since.

When she was 20 equipment failure during one of the dives caused Maria to sustain a spinal cord injury. Maria was rehabilitated from hospital. With professional support she was able to regain much of her independence although she suffers from chronic pain as a result of the injury, and anxiety and depression related to this. She uses a wheelchair and was allocated an accessible ground floor flat owned by a local housing association. Maria was advised that giving birth could further disable her but she was determined to have her baby.

Graham moved into Maria’s flat when she told him that she was pregnant. Shortly after this she cancelled her contract with the domiciliary care agency. She said that Graham was able to do everything that she and the baby would need. Graham took time off work to be present at every ante-natal class. He works full time at a race track. He sometimes has to work late and he doesn’t always know until he gets there how long the shift will be.

There has been a referral to adult services from children’s services. Children’s services have been alerted to concerns raised by health staff about Sophia’s lack of development, low weight and being frozen in her emotional responses. Maria is reported to seem tired, wary and dishevelled and potentially in need of social care support to be an effective parent. The housing association had had complaints from neighbours about the family’s dogs’ waste covering the shared ‘play’ area and that they seemed dangerous. Graham is reported to be offended at the idea that they are not coping as he now manages the household as well as working.

In this section are two downloadable PDFs – one is a partly completed assessment form related to this case study, and another is an example of what a completed form could look like.

Suggested exercise

Download the partly completed assessment as a PDF file (493KB)

Download the completed assessment as a PDF file (497KB)

Use the partly completed assessment form:

• What actions would you discuss with Maria to ensure her immediate and longer term safety?
• What precautions would you need to take to avoid putting her at higher risk of harm?
• What is your analysis of the situation? Is coercive control occurring? What is the evidence of this?
• What is your conclusion?

Download the blank DASH_RIC as a Word .doc file (226KB)

The purpose of the DASH risk checklist is to give a consistent and simple tool for practitioners who work with adult victims of domestic abuse in order to help them identify those who are at high risk of harm and whose cases should be referred to a MARAC meeting in order to manage their risk. If you are concerned about risk to a child or children, Safe Lives recommend that you should make a referral to ensure that a full assessment of their safety and welfare is made.

There are two downloads on this page.

One shows a blank DASH risk checklist, with quick start guidance from Safe Lives. The key point is to remember that your professional judgement is key in making a decision about risk; a tool can help, but the score it comes out with is not definitive.

This is especially relevant when working with people with care and support needs, for whom some of the questions may not be relevant.

Download the case study DASH-RIC as a PDF file (206KB)

The other shows an example of a completed DASH relating to this case study, for you to critique and appraise.

Suggested exercise:

• Read the case details and full assessment document for this case study.
• Using the information contained, fill out a blank DASH risk assessment tool.
• Discuss how you found it; did you have all the required information? Would you be able to get all the required information in practice? Would you make a referral to MARAC?

This section picks out three main topics from the case study featured. For Maria’s case study, the topics include:

Working with survivors with physical disabilities

Multi-agency working, adult safeguarding and child protection, support to eu migrants.

A selection of references, tools and further reading for each topic is below.

Studies focussing on domestic violence and the experiences of women with physical disabilities draw from survivors’ narratives that illustrate increased vulnerability to coercion and control:

‘ I mean, what normal wife would have all these professionals coming to the house and putting their hands all over her? All in the line of duty, but still—my body was for him alone . . .’ Bethany, a 36-year-old woman with multiple sclerosis, felt that her disability was an imposition on her husband; as a result, she felt obligated to sacrifice her home-based physical, speech, and occupational therapies … Bethany could not heal her disabled body; instead, she tried to limit its influence by surrendering her medical care. However, the abuse only escalated.’ (Rich, 2014:6) .

Findings from research:

People with care and support needs are at higher risk of domestic abuse and other forms of abuse:

• Disabled women are twice as likely to experience violence as non-disabled women. (Hague et al, 2008)
• Half of disabled women may have experienced domestic violence. The report criticises the ‘serious lack of research in this country on the experiences of disabled women survivors of domestic violence’ (Hague et al, 2007)

Less service provision:

• Domestic abuse services – are few and far between, with scarce resources whilst awareness of disability is often inadequate
• Disability services – domestic abuse is often not seen as an issue with a lack of training & information about domestic violence amongst staff compounded by a similar lack of resources. (Hague et al, 2008)

In conclusion, people with care and support needs are more vulnerable to domestic (& other forms of) abuse AND less likely to have access to the services and the protection that may be needed.

Violence and abuse – what can I do? Information for disabled or Deaf women : http://women-disabilities-violence.humanrights.at/sites/default/files/reports/gb_brochure_for_disabled_women_and_deaf_women.pdf

See tools, below:

• Tool 1: Safety Planning checklist for professionals
• Overarching tool on Making Safe Enquiries.  
• Case study 4 Tool 2: Social Work Capabilities in Working with Disabled Women Survivors

Home Office Statutory Guidance highlights perpetrator behaviour which preys on the victim’s fear of losing their child and using such threats as a means of coercion and control:

‘A victim may be fearful of their children being taken away if they make a report and the perpetrator may have tried to convince them that this is the case ‘  (point 23: Home Office Guidance) .

Because of their condition mothers with physical disabilities and/or learning disabilities may be particularly fearful of losing their child to the abusing partner or of losing their child into the care of the local authority. In such instances the perpetrator, as carer of both the adult and child/children, can use coercion to heighten this fear. Communication between Children’s and Adult services is crucial when situations of coercion and control involve elements of both child and adult safeguarding, requiring both adult and child assessments. Here is one example of a joint policy on working with adults and children experiencing domestic abuse:

Working_Together_To_Safeguard_Adults_and_Children_from_Domestic_Abuse.pdf

In seeking to establish robust and regular channels of communication between agencies, Professor Marianne Hester devised the Three Planet Model which highlights the need to align the Domestic Violence planet (where the perpetrator’s behaviour is considered a crime and therefore involves criminal justice professionals), the Child Protection planet (which resides in the public and family law arena involving statutory child protection professionals and NSPCC), and the Child Contact planet (the private law arena involving CAFCASS professionals who consider the child’s right to contact with both parent/perpetrator and parent/DV survivor):

http://www.bris.ac.uk/news/2009/6703.html

Adding a further planet to the constellation – the ‘Adult Social Care’ planet – highlights the need for additional communication channels between Children’s and Adult services and Adult services and Adult safeguarding professionals:

• Tool 3: The Four Planet model
• Tool 4: Family Model for Assessment
• See also: Topics and tools from Case study 5 (Betty) relating to using MARACs.

It is important to look at other structural issues that put people at risk alongside consideration of their care and support needs (see Intersectionality topic, case study 1 ). A number of reports signal a rise in hate crime towards EU migrants including attacks against their homes which, in their current situation, Maria and Sophia could find it difficult to escape from or to seek help:

Corcoran and Smith (2016) Hate Crime, England and Wales 2015/16

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/559319/hate-crime-1516-hosb1116.pdf

The increase in hate crime in England and Wales after the EU referendum vote was reported in figures published by the National Police Chiefs’ Council (Oct, 2016) showing a 49% rise in hate crime incidents to 1,863 in the last week in July 2016 when compared with the previous year. The week after saw a record 58% increase in recorded incidents whilst later data showed that the increase in hate crime continued, although the level of increase then dipped.

In September 2016 The Guardian reported:

‘Sir Bernard Hogan-Howe, the Metropolitan police commissioner, told a hearing at London’s City Hall in September 2016 that hate crime was showing signs of decreasing after the sharp rise in June and July, but it had still not returned to pre-referendum levels… He added: ‘The absolute numbers are low, but we think it is massively under-reported [crime]. Sadly, people don’t tell us about the harassment and the abuse that we know will go on out there.’

Sophie Linden, London’s deputy mayor for policing, who was hosting the hearing, said she was still getting daily reports about hate crime in the capital. ‘It is worrying that it does not appear to have gone back down to pre-referendum levels.’

A survey by the Guardian found that  European embassies in Britain had logged dozens of incidents of suspected hate crime  and abuse against their citizens since the referendum:

https://www.theguardian.com/society/2016/sep/28/hate-crime-horrible-spike-brexit-vote-metropolitan-police

• Tool 1: Checklist – Developing safety plans with adults with care and support needs experiencing domestic abuse

Professionals advising adults with care and support needs (referred to here as ‘adults’) and managing safety plans should follow the checklist of actions.

Tool 2: Social work capabilities in working with disabled women survivors

This tool is based on the recommendations drawn from disabled women’s suggestions for improvement in practice in Hague et al’s paper ‘Making the Links’ (2014: 26).

We have mapped the women’s seven suggestions to the domains of the Professional Capabilities Framework, and added our own suggestions on domains 6 and 9.

Tool 3: The four planets model

Based on Marianne Hester’s Three Planets model; with the addition of a fourth ‘planet’, Adult Social Care.

Consider all the different agencies who might be involved in a case like Maria’s.

Tool 4: Family model for assessment

You can use this tool to help you consider the whole family in an assessment or review.

Tool 1: Checklist - Developing safety plans with adults with care and support needs experiencing domestic abuse

Download the tool as a PDF file

  Professionals advising adults with care and support needs (referred to here as ‘adults’) and managing safety plans should:

• Establish how the survivor can be contacted safely and seek their permission to pass this information onto all professionals in contact with them
• Establish the location of the perpetrator, if separated from the adult
• Establish if the perpetrator is the adult’s carer.
• Obtain the survivor’s views about the level of risk
• Determine methods to facilitate any existing child contact arrangements safely
• Ensure that the survivor has the means to summon help in an emergency
• Identify where a survivor might go if they have to leave quickly and what they will take with them
• Encourage victims to report all incidents to the police or other organisations that will record the incident and maintain accurate and detailed records
• With their permission, refer the survivor to organisations that provide specialist support and advice
• Refer the case and details of the safety plan to a Multi-Agency Risk Assessment Conference (MARAC) in cases identified as high risk
• Encourage the victim to seek professional advice about legal and financial matters and child contact
• Inform survivors of criminal or civil law provisions which may be applicable, e.g., restraining or non-molestation orders
• Make survivors aware of the potential pitfalls of social media use, e.g. identifying current location through status updates/geo-location systems on smartphones which automatically update to publicly display current location
• Consider that victims with insecure immigration status, from minority ethnic communities, victims with disabilities or from socially isolated communities may fear contact with the police
• Where appropriate and safe to do so, involve the survivors’ friends, family or neighbours in the safety planning process where appropriate and safe to do so
• With permission, involve others professionals in the plan such as support workers, GPs, drug and alcohol services, mental health workers, schools etc.
• Encourage the survivor to keep a diary (where you have established it is safe to do so).
• Assess whether the adult has the mental capacity to make informed choices about how to protect themselves.
• Consider coercive control and the new law. Consider if there is evidence of this – i.e. isolation, control, intimidation, financial abuse.
• If you are aware that the adult is accessing other support services, consider who is offering specialised support for domestic abuse.
• Be aware of safety and confidentiality particularly around sensitive documentation for the survivor.
• Where the perpetrator is a caregiver, discuss how the survivor could continue to maintain their independence if they were to cease contact with the perpetrator.

Click to open the image full-size

Download the tool as a PDF file (577KB)

Domain 1        Take advice from, and consult with, disabled women.

Domain 2        Take disabled women seriously and avoid being patronising.

Domain 3        Develop accessible services.

Domain 4        Do not threaten disabled women with institutionalisation if no refuge space is available. Develop good accessible alternative accommodation, both temporary and permanent, plus support to use it.

Domain 5        Be informed about disabled women’s needs.

Domain 6        Critically reflect on power relationships and intersectionality.

Domain 7        Provide accessible well-publicised domestic violence services (including refuge accommodation) that disabled women know about.

Domain 8        Develop disability equality schemes and reviews with input from disabled women.

Domain 9        Contribute to the learning of others who are working with disabled women survivors.

Hague, G et al (2008) Making The Links; disabled women and domestic violence . Bristol: Women’s Aid.

Download the tool as a PDF file (490KB)

Below is an illustration of Marianne Hester’s Three Planets model; with the addition of a fourth ‘planet’, Adult Social Care.

What different perspectives and priorities do they bring?

You can use this tool when working with someone with care and support needs to discuss with them the agencies that can most usefully contribute.

Remember to use the principles of safe enquiry, and remember the limits of confidentiality and your responsibilities relating to child protection.

The Four Planet Model - click to view the image full-size

Download the family model for assessment as a PDF file (490KB)

Family model for assessment - click to view full size

Hague, Gill; Thiara Ravi K; Magowan Pauline; Mullender, Audrey (2008) Making the Links: Disabled women and domestic violence: Summary of findings and recommendations for good practice. Women’s Aid

Hague G Thiara R and Magowan P (2007) Disabled women and domestic violence: Making the links. An interim report for the Women’s Aid Federation of England . Women’s Aid

Rich, Karen (2014) My body came between us: accounts of partner-abuser women with physical disabilities. Journal of Women and Social Work , 1-16.

Woodin S, Shah S, Tsitsou L (2014) Access to specialised victim support services for women with disabilities who have experienced violence. University of Leeds. Available online:  http://women-disabilities-violence.humanrights.at/sites/default/files/reports/empirical_report_uk.pdf

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Victim of Disability: A Case Study

The paper talks about how a person with disability becomes a Victim of his/ her disability due to circumstances that are beyond his/her. The author of the paper has used the example of a case she worked on while doing her field work in Latur, Maharashtra. Key Words: Disability. Victim. Child Rights. Neglect. Abandonment. Human Rights.

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IAEME Publication

The National Policy for Persons with Disabilities (2006) recognizes that Persons with Disabilities are valuable human resource for the country and seeks to create an environment that provides equal opportunities, protection of their rights and full People participation in society. Touching the lives of all for ensuring their welding is the basic rule of good governance and development. Targeted interventions are required for the upliftment of people in any disadvantaged position. The main objectives of the study are to present the evolution of Disability Rights Movements (DRM) and to present an overview of the Persons with Disability (PWD Act, 1995) and Rights of a Person with Disability Act, 2016. The RPWD Act, 2016 provides that "the appropriate Government shall ensure that the PWD enjoy the right to equality, life with dignity, and respect for his or her own integrity equally with others." The Government is to take steps to utilize the capacity of the PWD by providing appropriate environment. The Governments, persons with disabilities and their representative organisations, academic institutions and the private sector need to work as a "team" to achieve the Sustainable Development Goals (SDGs).

Debasmita Chand

The history of Disability takes us as back as to the early civilizations, where Ancient Greeks had antipathy towards those with bodies that were ‘atypical’ according to their community. Towards the middle ages, there was the growth of faith based religious institutions with a charity approach to individuals who were ‘atypical’. Then in the era of Enlightment, disability was understood through scientific knowledge. Disability and the Disability studies in 21st century gained the attention of the academicians, activists and other social scientists. Disability is no more confined to the domains of rehabilitation professionals, therapeutic institutions functioning under the bureaucratic regime; rather it has shifted to the change among the differently abled people’s identity, their increased participation and the institutional sensitivity towards the barrier of exclusion of the disabled. But ‘Disability’ as a concept and the life of the impaired is always subject to vary from place to place depending upon the socio-cultural aspects. The present paper reviews some eminent theorist’s view of disability and presents how ‘disability’ was constructed, understood and interpreted throughout the journey from traditional sociological study to the emergence of disability studies as a distinct field of study. It also analyses disability in Indian context. Thus, the paper brings out some necessary dimensions that would help the disability researcher for the revaluation of the existing curriculum.

Arif Muntazir

Disability is not a new phenomenon since the origin of mankind , his/her status was andis decided on the basis of his/her abilities and disabilities. Untill the dawn of modern eradisability was treated as curse and the outcome of evil deeds of a family. Although modern technology like assistive devices has given new meaning to disability and they are treated as differently abled instead of disabled. But only a limited section of society have access to these assistive devices and are aware of it in most parts of our country, the status of person with disability is miserable and deplorable. Amongst these unfortunate area valley of Kashmir stands at top due to ongoing armed conflict and political unrest. The core objective of this research paper is to high light the plight of persons with disabilities and the callous response of state and society.

International Journal of Research

Edupedia Publications

Disability is a concept which is understood and interpreted by various social thinkers, social workers and jurists keeping in mind the inherent philosophy of the term in its actual sense. Though the term “disability” carries with it the assumption of a lack or deficiency whether physical, mental or sensory in respect of some people but there are lots of exemples that sometimes these people proved themselves as differently abled person by their intellectuality or positive attitudes and outlook towards life. Hence, the Rights and Laws of disabled persons need to be understood and studied from various perspectives including human rights and various other laws in India which will ultimately fill up the differences or mitigate the gap between the abled and the differently abled persons in their attainment of persona and dignity in true sense of the terms. In this research work the researcher is giving much emphasis on the various legal provisions and Laws available in our country and make a systematic study on how these laws have contributed towards the development of legal status of the disabled persons in India.

Sapna Sinha

Bandana Nayak

The attitude of society towards women with disabilities is very precarious across the world. More or less the same mindset also prevails in India. Because of high rate of illiteracy, ignorance and being a member of developing country in this twenty first century, no one come forward to sort out this issue totally from, personal, familiar, societal and governmental point of view. Many NGOs, Social activists and GOs are coming forward gradually to take up this issue as an important factor for the inclusive growth of the country, but it needs more thought process and rigor to include the disables in the main stream. Most of the disabled women are subject to violence, betrayed by husband, misbehaved by nears and dears. They are deprived of good education, livelihood for which they feel that they are marginalized. This study has emphasized on the conditions and status of women with disability, particularly in the state of Odisha (previously named as Orissa) in India. This study is a part...

nilika mehrotra

isara solutions

International Res Jour Managt Socio Human

Sometimes people misunderstand a word, it is more likely to happen when that word is associated with one aspect of human condition, the impact of culture and environment on the meaning of such words is more. Words such as disable, retard can have many meanings and can include feelings of prejudice, discrimination and abuse. Inability can be physical or mental. According to the United Nations Convention on the Rights of Persons with Disability"person with disability include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others". Indian Constitution section 41 of the Act mentions disability in terms of work and education. The Constitution of India guarantees equality to all citizens but the reality is that people with disabilities face stigma, discrimination and neglect due to social, psychological and cultural reasons. There is no doubt that there is a need for a comprehensive change in the institutional arrangements and legal provisions to realize the dream of discrimination and equal life for persons with disabilities, but the biggest need is a change in our thinking about persons with disabilities.

International Journal of Research in Human Resource Management

Abdul Karim Gazi

This paper explains the experience of people with socially constructed disabilities who don't continue their lives in normal way in their family, society, and own mother land and factors that lead them towards unproductive function in their society. I have taken three cases in my study who have been disabled by socially constructed factors. Respondents are male and female who have been disabled by their society in different ways from birth to present more or less as well as don't continue belonging in normal lives, leading in some cases to social instability and even dysfunction for society. This case study is conducted through the semi-structured questioning interview, journal, book and observation of the sample population with the aim of identifying the condition of people with disability and way of disability construction in our society. Generally, we know that people are disabled by natural process or because of accidents, but my study focuses on disability construction by social, cultural and economic factors. True, someone learn to speak, walk, adapt to others late or being raped. In this case, parents or family members or relatives are marginalizing them utterly from their own needs or rights that are basic need of them or constituted rights in their society or country. On the other hand, authority or local leaders aren't doing much more to combat these troubling trends. The census 2011 has shown 1.41% (101,585 people) people of Bangladesh are disabled. WHO has argued that 15% of global population are disabled all over the World among them 2-4% are not functioning for their societies. All people with disabilities have not been disabled by nature or accidents and social and cultural factors make them disabled. The respondents of my study such as have been disabled because of their adaptation to society late and social violence and problems. Thus, they have been excluded from society and have been disabled. So far policies have been made, the signs are not good, because their problems are not mitigated rather rising sporadically. Since social and cultural factors in conjunction is what allows disability rising is up to the authorities to make aware general population, enforce a suitable environment, and improve their basic needs and constituted rights. People should remain vigilant, keeping an eye on their bad condition. Solutions are fresh in my mind that by reducing social, cultural and economic factors what make disability could have an even bigger impact on mitigating problem of disabled people and help societies to prosper with health, education, and life expectancy improving significantly in many parts of the world. Along with Government strategies, private sector, with so much to gain and to lose from infection, should beginning to focus on their social and cultural status and position.

research journali journal of education

sheela rajeshwari

In the recent decades Disability studies is vibrant in the academic disciplines. The advent of interdisciplinary approach in disability studies and a developed understanding of disability through sociological, cultural & political lens frame have helped develop the new conceptual understanding of disability. Disability studies is an emerging concept in India. In India although plethora of disciplines exists, but, disability studies as an academic discipline requires an undivided, focused attention. This article attempts to critically examine the process of emergence of disability studies in western countries and discusses the related issues and possibilities in Indian context.

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