Debora A. Davidson, PhD, OTR/L Clinical Occupational Therapy Editor

Debora A. Davidson, PhD, OTR/L, Clinical Occupational Therapy Editor

You might end up wishing you hadn’t read this column, but doing so will prepare you for some of the most important work that you can do as a client-centered occupational therapist.

It’s about a topic that all too often gets swept under the rug. It’s a preventable public health issue, one that polite people do not like to discuss, and that even seasoned healthcare professionals find too disturbing to contemplate, sometimes blinding us to that which is before our very eyes. What is it?

Here’s a hint: The Report of the 2012 National Survey on Abuse of People with Disabilities was released in early September. The online survey, conducted by a team led by Nora Balderain, PhD; Jim Stream, and Thomas F. Coleman was completed by more than 7,200 people who identified as members or close associates of members of the disabled community.

While you may be prepared to hear that the news is bad, you will almost surely be alarmed to read just how bad. Here are a few key findings:

• More than 70% of all respondents with disabilities reported having been victims of abuse, including verbal-emotional abuse, physical harm, sexual violation or financial exploitation.

• Groups reporting abuse included those who identified themselves as having: mental health conditions (75%), speech impairment (67%), autism (66.5%), intellectual or developmental disability (62.5%) and mobility impairment (55%).

• The vast majority of those who had experienced abuse had been victimized multiple times.

• Most often, incidents of abuse went unreported to state agencies and unaddressed.

• Most of the people who were abused received no counseling.

• On a brighter note: 83% of those who did receive such counseling found it to be helpful.

Why does this problem exist? The formula for increased risk of abuse is simple:

1. Imbalance of power between one person and another/others

2. Vulnerability due to inability to move, speak out, care for oneself, belong or resist

3. Isolation

This formula describes almost every patient, client or student treated by an OT, especially those who reside or operate within closed settings where only a few people interact or observe day-to-day activities. It describes most residential institutions, day cares, classrooms and family homes. I am not saying that every client is the victim of abuse, but I’d point out most clients are at risk by virtue of their dependency and vulnerability.

So where does this leave us as therapists? Our professional code of ethics is clear on this matter, as are most states’ laws. We must gather our wits and courage to stand up for what is right and in the best interests of our clients. We are each powerfully positioned to prevent, or identify and intervene to stop abuse of all sorts. So let’s step to the plate.

Here is an action plan:

• Reduce isolation by promoting teamwork and open-door policies in care contexts.

• Look for signs of potential abuse, and ask your clients and reliable associates questions to find out whether there could be problems.

• Believe your client if he or she reports abuse, bullying, neglect or exploitation.

• Document your findings and share them with your team leader.

• Report concerns about possible abuse, neglect, exploitation or bullying to appropriate state or county authorities.

• Above all, educate yourself and other care providers about this difficult, all-too-common problem, and talk about it openly and often. The longer we all avoid it, the more it festers and grows. It’s time to look at this painful reality and deal with it directly, compassionately and assertively.

Lastly, join me in thanking and supporting the people who provide the kind of research conducted by the folks at the Disability and Abuse Project, and the many who are on the front lines, protecting and serving individuals who have suffered from abuse. They are my heroes, and I am proud to do what I can to support their efforts by volunteering as a Court Appointed Special Advocate ( But that is a topic for another day, and another column.

Read the full report at:

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