By Coralia Ivan-Suciu
Breaking Down Systemic and Individual Barriers
Ever since my career path has led me into the field of developmental disabilities, I became deeply troubled by the widespread abuse and neglect which continue to plague this particular field. I soon realized that policies and procedures that were meant to protect the most vulnerable are filled with loop holes and inconsistencies which make it impossible to accurately address the root of the problem and hone in for a viable solution. Systemic differences in the regulatory protocol, lack of a unified and transparent reporting system and the existence of conflicting interpretations and implementations are likely to be contributory to the propagation of the abuse culture.
The question of “why is this population abused” has an easy answer. It involves a combination of factors related to the social and physical environment in which people with disabilities live and also the very characteristics of the specific person (Thornberry, 2005). In this short analysis, my focus is to explore the factors related to the physical and social environment of people with disabilities living in an institution-type facility. I will examine sets of variables/trends that may constitute fertile ground for abuse as well as look at dysfunctional work patterns of staff. Additionally, I will examine the interplay of individuals’ characteristics with those of staff and the resulting dynamic which often leads to abuse. My findings are simply anecdotal and represent descriptive data which I intend to utilize to suggest possible modalities to correct and improve the chronic issue of abuse.
I am going to propose three principal motivators for abuse within residential institutions both state-based and voluntary agencies, describe their operation and then propose effective ways of addressing these in a meaningful manner. The three main motivations responsible for abusive behavior that will be examined in this conceptual framework are: social conformity, the burn-out/under-compensation syndrome and the dynamic created by individuals’ characteristics blended with characteristics of workers in this field. Each of these, I will show, has a major role in the maintenance of “abuse tendencies and behavior” and each gets perpetuated from generation to generation in a cyclical pattern.
Social conformity is defined as the tendency to follow a particular behavioral response in order to fit in with a group. This situation can be easily observed within a residential institution. Whenever a new staff is recruited, he/she typically comes aboard with an open- minded attitude, willingness to learn and sometimes with a healthy work ethic. Regardless of their initial enthusiasm and work attitude (including moral principles which are all intertwined in the equation), this person will quickly learn that in order to survive in the new environment, he/she will need to adopt the “mold” or the culture of that particular house. Some will be absorbed into this culture completely while some will accommodate with a level of discomfort still present.
Research has shown that, in most institutions (with exceptions, of course), individuals with special needs are perceived as less than, pitied, not seen as credible and often infantilized (Thornberry,2005). Negative stereotypes abound as well as prejudices. Compliance is always expected and individual rights are often overlooked for safety’s sake. Once such beliefs are universally held by the staff, abusive behavior follows- yelling, demands, orders, the scheduling of strict routines which are not to be broken, uniform eating times, bathing times, threats, rehashing of past negative events, all types of restrictions (including food in the absence of dietary or medical considerations) which are not only unnecessary but also lack the approval of the Human Rights Committee. These are on the lighter side- then of course, physical abuse, sexual and so forth constitute the more severe types. Interestingly enough, the milder abusive behaviors are more frequently noted and more easily overlooked and under-reported. In fact, these will result, over time, in the re-traumatization of the individuals in question creating a never-ending cycle of abuse. Trauma in itself has deep ramifications which can last a life-time and may interfere/impact various aspects of one’s life .
Within the field of disabilities, social conformity plays an immense role in the continuation of the abuse cycle. Worth-noting is that the person engaging in this type of behavior feels he/she is doing his best to care for the most vulnerable. Staff often hold the idea that he/she is doing the individuals served a favor. And therefore the person served should accept the “basics” without any other pretensions. In reality, the staff work for the individuals (not the other way around) and are being compensated by state funds belonging to the individuals in question.
When asked about their inappropriate actions (such as raised voices, unauthorized restriction of food etc.), these workers reply that they keep the individuals safe and the restrictions are for their own good as “they don’t know any better”. Although large-scale institutionalization for the disabled group is no longer the norm (as in the Willoughbrook State School or the developmental centers which have all been closed down), the tendency to “control” versus. teach and assist seems to prevail as far as staff mentality is concerned.
What is the solution and how can this social conformity be remediated? Education, education, education. Ensuring that all staff are adequately and thoroughly trained in multiple modules that deal with the developmentally disabled population characteristics, behavior, strategies, positive supports, rights and regulations is absolutely vital. Education then has to be followed by correct and consistent implementation (practical application) and frequent observation/monitoring by supervisors. Staff should feel open to discuss any potential misunderstandings or ambiguities and be given the opportunity of re-training or undergoing additional training. Although mistakes should be followed by appropriate consequences, the focus should NOT be on the punitive. Instead, it should be on building confidence in staff’s skills and mastery, encouraging open communication and collaboration between the different strata of workers/managers/supervisors and recognizing progress and achievement (even if the latter is not momentous).
The second component in preventing social conformity-based abuse has to do with the responsibility of the staff themselves. Promptly reporting abuse seen or heard is a huge necessity. This is NOT a time for cover-ups or “protecting” your team. The allegiance should be to the individual served. If every staff conscientiously reports every sign of abuse or pre-abuse, and the person who engaged in the respective abuse receives ample training and clarification in what can be done differently, the cycle will eventually be broken.
The Burnout/Under-Compensation Syndrome
Staff who are employed to work with individuals with special needs often have little training and education in this field and are payed the minimum salary. Some start out in the field with no awareness of the difficulties and job stress that will follow. Taking care and supporting adults with disabilities in a group home is not an easy feat to accomplish. Support and assistance is required on multiple levels-physical (help with completing activities of daily living, walking, bathroom use, eating etc.), social and behavioral (dealing with maladaptive manifestations, difficulty in verbal communication, reduced knowledge of social rules and engagement etc). After a while, even enthusiastic workers begin feeling the exhaustion and desperation.
Although a regular shift typically lasts 8 hours, due to staff calling out sick and the unavailability of temporary staff, workers are often asked to cover 2 or more shifts. Yes, the advantage of over-time initially sparkles like gold. Eventually, gold turns to pewter and so does the physical and mental health of the staff. The staff knows very well he/she needs this job and may also have, initially enjoyed engaging in this type of work. However, covering multiple shifts, being tired and over-worked can quickly change one’s mental shift. Thinking becomes clouded and errors of judgment may result. Fear of the repercussions and losing one’s job will often force a worker to cover up an infraction and continue on without reporting. When the new person/staff coming in observes this type of behavior, he/she will follow suit. It is easy to note how the burnout-under-compensation syndrome is closely related and maintained by the social conformity attitude.
What is the recourse? Ensuring that ample staff are available on the stand-by and taking care of staff’ needs especially their mental health. Supervisors seeking out solid and dependable staff need to go through the motions of ensuring the satisfaction and well-being of their staff. Even super-resilient people cannot make it work with 3 hours of sleep and no time to refuel their mental batteries. Throughout my many years in this field, I have personally watched the decline of great, dedicated staff into sluggish, depressed and traumatized human beings who were more likely to engage in unacceptable behavior with their individuals. The reality is that abuse is more likely to occur when staff are chronically overworked and underpaid (Verdugo & Bermejo,1997).
Top on the list of recommendations for any supervisory/management unit is to constantly maintain a running dialogue with their subordinates. Similarly, being trusting and supportive and checking on them frequently will strengthen their professional and personal bond and will lead to positive outcomes for all involved. Conversely, staff should feel understood and free to express/question responsibilities/clarify issues with their direct supervisors. If a dedicated, hard-working staff is unable for whatever valid reason (physical or psychological) to deliver another shift, this person should not be penalized. Naturally, there are exceptions (as far as the rationale for refusing as well as shortage of replaceable/alternative staff). On the other hand, if the staff requests consecutive shifts due to financial difficulty (and is deemed by the supervisor as unable mentally to sustain this effort), staff should have the opportunity to work extra days or be allowed to pursue possibly different additional positions. Burnout and under-compensation can be preventable when there is communication, understanding, patience and the will for collaboration as opposed to control. In the long run, it can save an individual’s mental anguish and trauma resulting from possible abusive actions. Staffing investment necessitates leaders with visionary mentalities who focus on the future rather than immediate needs, who understand building social capita and can assess dividends not yet observed.
The interplay of individuals’ unique characteristics and behaviors and the traits of the staff working with them make for an interesting dynamic. This dynamic may often lead to the perpetuation of abusive behaviors. There is some evidence that personality traits of staff such as low self-esteem and impulsiveness can affect the way people with special needs are treated (Bromley and Emerson, 1995). Staff’ reactions to stress together with their low or inadequate repertoire of coping skills can also play a role in the etiology of abusive actions (Rose, David and Jones, 2003).
The idea that abuse is somehow “justified” through a reduction, even dilution of moral and ethical standards was suggested by Wardhaugh and Wilding (1993). More specifically, stereotypes that maintain that individuals with disabilities represent nuisances and burdens to society and therefore deserve “lesser care”, maybe even mistreatment, are still prevalent among caretakers. However, such beliefs and preconceptions can be corrected (as previously mentioned in this article) through education and training.
It is a known fact that challenging behaviors occur at a higher rate within the developmentally disabled population which in turn significantly increase the stress level of the staff providing care for these individuals. The element of fear and unpredictability coupled with the position of power makes for an excellent combination of factors leading to abuse. Stress is further exacerbated by lack of sleep, working multiple shifts, the lack of collaboration from other staff and possibly reduced support from supervisors. Once a pattern of behavior is formed (i.e. anticipation that a behavioral manifestation will occur which is preempted by a threat or unauthorized restriction on the part of the staff), the abuse sequence will only become stronger in time.
Last but not least, the quality of interaction between staff and their supervisors (Cambridge, 1999) and the efficiency of the system of checks and balances utilized in the specific setting (as far as supervision, tolerance of abusive behaviors/transparency and disciplinary actions) have a great impact on the the culture of abuse. A culture of accountability and zero tolerance will naturally encourage accurate and consistent reporting which will in turn decrease the incidence of abuse. Conversely, a tolerant culture whereby reporting is frowned upon, misunderstood and haphazardly practiced, will lead to higher rates of abuse by staff of this population.
In conclusion, I reviewed in this analysis three principal motivators of abuse: social conformity, the burnout/underpaid syndrome and the interplay of specific staff/individual characteristics. I have provided detailed explanations of each motivator’s functional mechanism, listed the contributory forces and how each trend is maintained within a residential setting. Later on, I proposed viable solutions for changing/remediating each of these causes in an attempt to lower the rates of abuse within residential facilities caring for the developmentally disabled.
Abuse constitutes a serious social problem. Only by continuing to raise awareness of its existence and exposing detrimental patterns of behavior that are deeply entrenched within facilities will be able, as a society, to abolish these shameful trends. Education and training for any caretaker who wishes to explore the field of disabilities should be extensive and readily accessible. Training should also become part of the mandatory curriculum for staff in this field, to be revisited and refreshed on a regular basis by teams of professionals (doctors, psychologists, supervisors, educators). Supervisors, managers and all leaders involved in the decision-making and planning processes for residential facilities have the responsibility of ensuring the safety of all the individuals. In order to carry out this complex task, concerted efforts need be put forth which include but are not limited to frequent supervisory visits and checks, team building exercises, opportunities for both staff and individuals to share social gatherings and building rapport etc.
Society will need to switch its focus from a deficiency-based perspective to a strength-based assessment of those with disabilities. Only when the developmentally disabled individuals will be perceived in terms of their complex and innumerable strengths, talents and positive characteristics, the world’s mentality will change for good. People with developmental disabilities have to be looked at with the same measure that all of those without disabilities are looked at. Healthy thought processes and belief systems, guided in reality and driven by positive emotions such as gratitude, empathy and the desire to build up (as opposed to tear down) are capable of modifying behaviors and these in turn, may change lives. Each and every one of us is morally responsible for this process and every effort, at every level counts.
Bromley, J.,& Emerson, E. (1995). Beliefs and emotional reactions of care staff working with people with challenging behavior. Journal of Developmental Disability Research, 39, 241-342.
Cambridge, P. (1999). The first hit: A case study of the physical abuse of people with learning disabilities and challenging behaviors in a residential service. Disability and Society, 14, 285-308.
Rose, J., David, G., & Jones, C. (2003). Staff who work with people who have developmental disabilities: The importance of personality. Journal of Applies Reseach in Developmental Disabilities, 16, 267-277.
Thornberry, C. & Oson, K. (2005). The abuse of individuals with developmental disabilities. Developmental Disabilities Bulletin, (1&2), 1-19.
Verdugo, M.A., & Bermejo, B.G. (1997). The mentally retarded person as a victim of maltreatment. Aggression and Violent Behavior, 2(2), 143-165.
Wardhaugh, J., & Wilding, P. (1993). Towards an explanation of the corruption of care. Critical Social Policy, 37, 4-31.
Coralia Ivan-Suciu is a Psychologist II with the Long Island Developmental Disabilities Service Office in NYS. She currently provides psychological oversight for several residential facilities within OPWDD. Her work involves assessment, intervention and implementation of behavior support planning and related services for adult individuals with various types/levels of disabilities and comorbid psychiatric diagnoses.
Coralia’s training and experience includes theoretical and applied work in the following fields of study: psychopharmacology, learning and development, psychopathology, special education, adult/child, individual and family counseling with the typical and neurodiverse populations as well as psychosexual counseling. Coralia has worked in crisis intervention services (children and adults) for a number of years where she gained important experience working with the entire family unit, forensics as well as many culturally-diverse populations and complex medical-psychological diagnostic profiles.
Coralia Ivan-Suciu is a passionate and dedicated professional, an ardent advocate for the person-centered approach and the biopsychosocial paradigm for treatment and intervention.
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