Disability Inclusion in Child Protection and Gender-Based Violence Programs

Women's Refugee Commission
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Guidance on Disability Inclusion for GBV Partners in Lebanon: Case Management of Survivors & At-risk Women, Children and Youth with Disabilities

February 2018

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ACKNOWLEDGEMENTS

This resource is a product of a partnership project between the Women's Refugee Commission (WRC) and UNICEF Lebanon entitled “Strengthening child protection and gender-based violence prevention and response for women, children, and youth with disabilities”. The overall goal of the project is to improve violence prevention and response programming for at-risk groups of women, girls, and boys with disabilities.It builds on existing initiatives of gender-based violence (GBV) and child protection (CP) actors to systematically advance disability inclusion across the CP and GBV prevention and response sectors in Lebanon.

This resource has been developed based on the findings of a needs assessment conducted in 2017 which:

Other resources developed in the project include:

The WRC and UNICEF Lebanon thank the following organizations and stakeholders for their contributions to the project, including participation in consultations, the needs assessment and feedback or review of tools and guidance:

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CONTENTS

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1. INTRODUCTION

Approximately 15 per cent of any community may be persons with disabilities. 1 There may be even higher rates of disability in communities affected by crisis or conflict, 2 as people acquire new impairments from injuries and/or have reduced access to health care. In Lebanon, it is estimated that 900,000 persons are living with disabilities. 3 Persons with disabilities are one of the most vulnerable and socially excluded groups in any crisis-affected community. They may be in hidden in homes, overlooked during needs assessments and not consulted in the design of programs. 4 While gender-based violence (GBV) affects women, girls, men and boys, the vast majority of survivors globally are women and girls. 5 Persons with disabilities have difficulty accessing GBV programs, due to a variety of societal, environmental and communication barriers, increasing their risk of violence, abuse and exploitation. 6

The Lebanon Crisis Response Plan (LCRP) 2017 – 2020 recognizes that children with disabilities are at a higher risk of violence, abuse and exploitation, both inside the home and in the wider community, with women and girls with disabilities being among the most vulnerable to GBV. Both the LCRP and the Ministry of Social Affairs National Plan to Safeguard Children and Women in Lebanon 2014 – 2015 highlight commitments to strengthening national protection, child protection (CP) and GBV systems ensuring that women, girls and boys at risk and survivors of violence, exploitation and abuse have access to improved and equitable prevention and response services. 7 8

A needs assessment conducted in 2017 confirmed that women, children and youth with disabilities in Lebanon and their caregivers are facing a range of GBV-related risks including:

Despite these increased risks, women, children and youth with disabilities report a lack of information and awareness on GBV-related activities and how to access case management services, due to both physical and attitudinal barriers to accessing such services. 10

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GBV Case workers and Supervisors play a critical role in ensuring that women, children, and youth with disabilities who are at-risk of GBV, and/or have experienced GBV receive appropriate support and follow-up.

1.1 Purpose of the Resource

Guidance on Disability Inclusion for GBV Partners in Lebanon: Case Management for Survivors & At-risk Women, Children and Youth with Disabilities is designed to support GBV Case Workers and GBV Supervisors to strengthen case management services for survivors and at-risk women, children and youth with disabilities, and to uphold GBV guiding principles while working with these individuals. It includes guidance, key actions and tools to improve accessibility and inclusiveness of existing case management processes and activities.

1.2 How to use this Resource

This resource complements, and should not be used in isolation to, existing GBV prevention and response procedures, guidance and training in Lebanon, including:

The material presented in this guidance should be adapted and integrated into existing guidance, tools and trainings. It features boxes to inform case managers and supervisors of key actions they should take, as well as to direct them to sample tools and suggested training materials.

2. UNDERSTANDING DISABILITY

It is important for all GBV actors to recognize persons with disabilities, and to understand different approaches that can be applied when working with persons with disabilities in the community.

2.1 Concept of Disability

The definition of disability continues to evolve over time. It is important to remember that persons with disabilities are not a homogenous group; they have different capacities and needs and contribute in different ways to their communities. 11

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The national Lebanese Law 220/2000 defines a person with a disability as “a person whose capacity to perform one or more vital functions, independently secure his personal existential needs, participate in social activities on an equal basis with others, and live a personal life that is normal by existing social standards, is reduced or non-existent because of partial or complete, permanent or temporary, bodily, sensory or intellectual functional loss or incapacity, that is the outcome of a congenital or acquired illness or from a pathological condition that has been prolonged beyond normal medical expectations.” 12

Article 1 of the UN Convention on the Rights of Persons with Disabilities (CRPD) states:

“Persons with disabilities 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.” 13

An impairment is a problem in the body's structure or function. 14 Impairments may be physical, intellectual, psychosocial and sensory.

Disability, however, is not just a health problem or impairment. Societal attitudes and a person's environment have a huge impact on their experience of disability and their access to our activities.

Improving access and inclusion for people with disabilities requires interventions to remove these different types of barriers in our GBV activities.

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2.2 Models of Disability

There are different ways in which society may view or interact with persons with disabilities that can result in their exclusion or inclusion in our society. There are four different approaches or “models” that describe how members of society view or interact with persons with disabilities:

Both the charitable and medical models result in other people making decisions for persons with disabilities and keeping them separate from society. The social and rights-based models, however, are aligned with the guiding principles for GBV prevention and response and should therefore guide the work of development and humanitarian actors, as well as governmental entities, with persons with disabilities, their families and communities.

Previous needs assessments in Lebanon have highlighted that family members, communities and service providers often view persons with disabilities through medical or charitable models, failing to recognize social factors, such as age and gender, that may increase their vulnerability to gender-based violence, requiring inclusion in prevention and empowerment efforts, and / or referral to case management agencies for appropriate follow-up. 16

2.3 Rights of Persons with Disabilities

The move towards a rights-based approach for working with persons with disabilities has gained significant international momentum over the past decade with adoption of the United Nations Convention of the Rights of Persons with Disabilities (CRPD). Persons with disabilities have a right to protection in situations of risk or in humanitarian crisis and should be able to both access services and participate in GBV programs and activities on an equal basis with others. 17 Persons with disabilities have a long history of discrimination and disempowerment by family members, caregivers, partners, and even service providers. GBV actors can play a central role in supporting women, children and youth with disabilities to make their own decisions and addressing the barriers they experience in their relationships, households and communities. GBV actors must use a rights-based approach when working with persons with disabilities, ensuring women, children and youth, with or without disabilities, have the same access to their programs, services and support.

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3. ADDRESSING EXISTING ATTITIUDES & ASSUMPTIONS RELATED TO PERSONS WITH DISABILITIES

Social norms discriminate against and stigmatize people with disabilities. They may be ostracized or neglected in their communities and fear seeking support from family and community members. Service providers may also exclude persons with disabilities based on beliefs that GBV prevention and response services are not relevant to or appropriate for persons with disabilities, or out of fear of engaging with persons with disabilities.

Below are some common assumptions that are often made by service providers, caregivers, and community members about persons with disabilities, along with the facts and findings that challenge these assumptions.

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Common Assumptions Findings & Facts
A person's disability defines their identity as an individual.

Persons with disabilities are women, girls, sisters, brothers, cousins and parents. They have unique skills and capacities and many roles that they play in their families and communities. It is important to let persons with disabilities define which group or characteristic they identify with the most.

“I always want to tell new people that I am more than my disability and that I have many characteristics that define me better than just my disability. For example, nationality, my religion, the fact that I am a woman and a wife and someone who teaches religious lessons to children – all of these things make up my identity.”- Women with a sensory disability in Lebanon

You can tell if someone has a disability by looking at them. Some disabilities are visible – for example if a person uses a wheelchair. Many disabilities, such as psychosocial and intellectual disabilities, may not be visible. However, people with these types of disabilities may still be stigmatized in communities and experience discrimination.
Persons with disabilities can’t make their own decisions.

Adults with disabilities have the right to make their own decisions and know what the best option is for them. Even people with more profound communication difficulties may understand everything that is being said to them, and with appropriate support, may be able to indicate their wishes and preferences to others.

“They started to yell at my family for bringing me and making me ‘suffer’. I got very defensive and told them ‘I am the one who wanted to go, they didn’t want to take me, and I convinced them to. This was my choice because I wanted the chance to meet other people and learn from the training.’” — Older woman with a physical disability in Lebanon

Women, children, and youth with intellectual disabilities do not need knowledge and awareness about GBV.

Persons with intellectual disabilities need knowledge and awareness of GBV, as they are at higher risk of experiencing sexual abuse than their non-disabled peers. 18 They also have the right to safe and healthy sexual relationships. 19

Persons with intellectual disabilities can learn new things and participate in our activities, with just some small changes to the way we work and share information. For example, pictures can also be used to communicate messages to people with intellectual impairments – these are sometimes called “Easy to Read” documents.

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Persons with disabilities need a lot of additional support and adaptations to participate in our activities.

Most persons with disabilities require very few adaptations to participate in our activities. They just need to be invited and given the chance to participate. Individuals with disabilities are the experts in the type of support and adaptations needed and can advise you appropriately.

“I tell people not to feel badly for me and not to baby me … I go to the park and do things on my own – sometimes I need help with my wheelchair, but that's about it.” – Young woman with multiple disabilities in Lebanon

Persons with disabilities are safer in residential facilities. Globally, research demonstrates that persons with disabilities who are living in residential institutions are at higher risk of sexual violence than those living in the community. 20
Persons with disabilities will be harmed or get sick from coming to our activities or services.

Most persons with disabilities are not sick or in pain. During the needs assessment in Lebanon, none of the people consulted reported harm from attending GBV prevention and response activities. Instead, they shared that attending these activities had a positive impact on their mental and physical health and helped them to expand their peer networks.

“Sometimes parents or staff get are worried about keeping these people safe – however, we have never had anyone get sick or injured while they are here – most are really happy to be invited and the parents are seeing the benefits.” – Staff member from SDC in Mount Lebanon

Concerns that staff may have about the health or harm can be directly addressed with the person with the disability — they can share strategies that they use to avoid injuries in their everyday life.

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It is important that all GBV staff engage in learning activities that reflect on their attitudes and assumptions about persons with disabilities. Supervisors can encourage this process by having staff engage in an initial activity to assess their attitudes and assumptions, and from there start open conversations about their ideas and beliefs in relation to persons with disabilities.

4. GUIDING PRINCIPLES FOR WORKING WITH SURVIVORS WITH DISABILITIES

All interventions aimed at preventing and responding to GBV are guided by the principles of safety, confidentiality, respect, and non-discrimination – also known as the survivor-centered approach. These principles help to promote the survivor's recovery, strengthening their ability to identify and express their needs and wishes, and reinforcing their capacity to make decisions about possible interventions. 21 Case Workers must ensure these guiding principles are implemented when working with survivors with disabilities.

PRINCIPLE 1. Ensure Safety

Case workers should start by getting to know the individual with disabilities – the things they like and dislike, and the ways they behave and communicate when comfortable, happy or distressed. This will help the case worker to better understand when a survivor does and does not feel safe talking to the case worker. Watch for signs of agitation, anger or distress that may indicate the individual is not happy to proceed at this time, and respect this, especially if you are talking with the caregiver.

Some persons with disabilities may require assistance to communicate effectively with case workers. The decision about who to involve and when should be made in partnership with the survivor and include an analysis of risks to the survivor's safety if they choose to involve another person. Case workers should be aware that caregivers of persons with disabilities may also be perpetrators of violence. Case workers should discuss with the survivor their relationships with family members and both primary and secondary caregivers – this will help to identify appropriate risk mitigation strategies 13 where a caregiver is a perpetrator, as well as protective relationships that may support the survivor's recovery.

Case workers must also ensure that the space in which they speak to the survivor feels safe and should follow existing guidance on selecting counseling and meeting spaces. Given the environmental context in Lebanon, it will not always be possible for GBV service providers to have fully accessible counseling spaces. Hence it is recommended that GBV program staff conduct a small mapping in each region to identify at least one accessible counseling space or mobile safe space per district with safe and confidential transportation arrangements for those survivors who will require it. Ideally an accessible counseling space should be a location where GBV counselling already takes place and meets the following guidance:

Case workers and supervisors should work together to develop options to ensure that all survivors can receive case management. This may require developing new strategies for reaching those who may be unable to attend a service facility, such as adults with more profound disabilities who are unable to leave their homes or those who face severe risk of harassment or abuse when in the community. Home visits should be considered as a last resort, when there is no other option for the survivor to receive appropriate support. Case workers and supervisors should decide together if a home visit is the only option to provide case management services, and develop a thorough risk assessment with appropriate mitigations strategies. Some options to mitigate risks associated with home visits to survivors with disabilities include:

PRINCIPLE 2. Respect Confidentiality

Any support persons engaged in the case management process, family members, caregivers and/or sign language interpreters, should be briefed on the principles of confidentiality. The case worker should also provide appropriate caregivers and family members with information about how to be supportive of the 14 healing process (e.g., by maintaining confidentiality; by not judging or blaming the survivor; and by not pushing them to take a particular action or service). Participatory activities may also be useful to assist persons with intellectual disabilities to better understand the principles of confidentiality; decide who they may and may not want to share information with; and to explore different strategies or ways to respond to questions from others.

Describing confidentiality to persons with intellectual disabilities

Confidentiality means that when we tell someone something private or personal about ourselves, they can’t tell anyone else unless they have our permission. If someone respects you, they won’t share your personal information. (Expand or simplify as necessary.) The professionals we go to when we have concerns about our bodies (like doctors or nurses) or our feelings (counselors or social workers) must keep things confidential … I want you to feel safe talking about your feelings, so we have a rule that all of us (point to self and support people) will keep what we discuss CONFIDENTIAL. If family members, friends, parents or others ask what we talked about, we say “That's confidential.”

Adapted from Arc of Maryland (n.d.) Personal SPACE – A Violence Prevention Program for Women http://www.ncdsv.org/images/Arc_PersonalSpace-AViolencePreventionProgramForWomen.pdf

PRINCIPLE 3. Respect their Wishes, Rights and Dignity

Persons with disabilities have the right to make their own decisions and it is the job of the case worker to assist in upholding this right. In situations where a protective caregiver is involved, the case worker can still empower the survivor by: directing the conversation to the survivor first; asking permission from the survivor to consult with the caregiver from the very beginning and throughout the conversation; and checking back in with the survivor throughout the process.

In the past, the survivor with disabilities may have been dismissed by others when trying to communicate their feelings and experiences. As such, the case worker should reassure them that they are believed, validating any experiences and emotions that they share. The case worker can validate a survivor's feelings and convey empowering messages through both verbal and non-verbal techniques, i.e. using drawing, pictures or body language, particularly facial expressions. It may take some time to establish ways of communicating with the survivor that allows the case worker to convey these important messages –throughout this process case workers should remain thoughtful and creative.

PRINCIPLE 4. Non-discrimination

The guiding principle of non-discrimination means that case workers provide the same quality and range of service options to every survivor. It is important to present all available options to survivors with disabilities, even if it is not yet clear are how they will participate in these activities. Present all the options in a way that the survivor will understand. Be prepared to try several different ways of communicating these options (e.g., if there is an English class in your women's center, support the survivor to visit the class to show them what it involves). Give the survivor time to think about these 15 options and to ask questions. If the survivor expresses interest in a particular service or activity, then discuss together the potential barriers and strategies to address these.

5. DECISION-MAKING AND SELF DETERMINATION

“Informed consent” is when permission is granted with full knowledge of the possible consequences, risks, and benefits, and choice is free and voluntary. The CRPD highlights that adults with disabilities have the same rights as everyone else to make their own decisions, and that where appropriate measures must be taken to support them to make their own decisions. 24 An adult cannot lose their legal capacity to make their own decisions because they have a disability. 25

5.1 Informed consent process 26

The informed consent process has three key components:

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When conducting the informed consent process, it is important for case workers to remember the following:

Consent is an ongoing process and not a one-time event. It is important that we never assume that a survivor's consent to one service means that they consent to everything.

A Note About Children with Disabilities: In accordance with the Inter-Agency Standard Operating Procedures (SOPs) for SGBV Prevention and Response in Lebanon, children with disabilities above 15 years of age are able to participate in the informed consent process as individuals. However, their parent or a trusted adult should be included with the child's permission, unless they are involved in the abuse. Children under 15 years of age can participate in an informed assent process, but require the permission of a non-perpetrating parent or caregiver as well. 27 For additional information, please see the Standard Operating Procedures for the Protection of Juveniles in Lebanon (and the annexed guidance on working with children with disabilities).

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5.2 Informed Consent Flow Chart 28

image

Image Description

This image shows a flowchart illustrating informed consent procedure which to be adopted for disable children and adults. The chart contains 14 stages or steps of lessons to be followed by case workers.

Step 1 depicts for assuming capacity. Steps 2-4 show the following options: provide information as to be understood by survivor; give enough time to think and be able to ask questions; if for speaking disability, to adopt any other gesture for agreement or disagreement or provide a sign interpreter. These steps may be repeated for several times. Steps 5-10 follow several questions and some examples of such questions, to be quite sure about the mental ability of the disable persons to properly understand these options. Some of these questions are like such: “Do they remember the information?”; “Do they understand that there are options”; “Is the person being coerced?”; “Can the survivors explain the reason for their decision?” etc. Each of them provide both ‘Yes’ and ‘No’ choices. At the end of step 10, survivor's decision is to be followed. Then comes step 11, that asks—“What are the wishes and preferences of the survivor”, which also to be followed after repeating steps 2-4 several times. It also needs documentation regarding communication strategies implemented and the steps which the survivor didn't understand. No. 12 asks—“Is this the least harmful course of action?” and need documentation of the negative and positive outcome of action on survivor's physical, emotional and social well-being. For positive outcome of action it is advised to “Respect the wishes and preferences of the survivor”. For negative outcome, steps 13 and 14 are to be followed. No. 13 advises to “Identify someone to support the survivor in decision-making” which includes: ‘allow them to choose who they trust’ or ‘discuss any risk for engaging this support person’. Lastly, step 14 monitors the quality of interaction between the support person and the survivor and looks for any signs of fear, threat, deception or anything like such.

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5.3 Involving a trusted support person in the informed consent process

After trying multiple communication approaches, if the case worker is still unsure that a survivor understands the information, they should involve a supervisor to help determine whether there is a need to provide additional support for informed consent. The survivor may wish to involve a trusted support person.

Family members, caregivers and peers of persons with disabilities can be a valuable resource in facilitating understanding and communication with the survivor. If you determine that it is safe to do so, ask the survivor's permission to include someone they trust in your discussion as a way of supporting communication and enhancing the survivor's ability to provide informed consent. Let the survivor identify who they would like to involve and watch for any signs that they agree or disagree with the suggestions being made by the support person. The decision to engage a caregiver must always be reached by analyzing the survivor's situation with respect to safety.

If caregivers or others are involved, it is important to ensure that the survivor's wishes and needs remain the focus, and that the survivor feels safe. Be sure to observe the survivor's interactions with the caregiver. If the case worker feels the power dynamic and relationship between the caregiver and the survivor is affecting the right of the survivor to participate in decision-making and/or if decisions are not aligned with their wishes and preferences, they should consult with a supervisor on how to proceed.

5.4 Ensuring the rights, wishes and preferences of survivors with disabilities

When involving others in the informed consent and decision-making process, remember:

6. ENGAGING CAREGIVERS AND FAMILY MEMBERS OF PERSONS WITH DISABILITIES

It can be very useful and in some cases necessary to work with the survivor's caregiver(s) and/or family members. However, doing so can also complicate efforts to promote the safety, confidentiality and the interests of the survivor. Persons with disabilities should always be consulted on the involvement of caregivers and family members, as would be the case with all survivors.

6.1 Maintaining a survivor-centered approach

It is paramount that case workers always focus on the survivor.The survivor is the individual seeking services and all actions should be guided by their will and preferences. The interests of family members and caregivers may or may not be linked to the will and preferences of the survivor. For example, caregivers may want to pursue justice options. If the survivor does not understand the legal processes involved, then it is unlikely to promote healing and recovery, and may even expose them to further emotional harm, as they will have to recount their experiences to others. If the referral is not in the interest of the survivor, the case worker should not proceed, even if requested by caregivers. It is essential that the case worker explain to caregivers the importance of respecting the survivor's wishes, and any possible harm that could be caused to the survivor by certain actions. Exploring the reasons why caregivers think certain actions are in the best interest of the survivor can help to come to decisions that respect the needs and interests of the individual, and identify support that caregivers may require for themselves. 32

It is also important to maintain confidentialitywhen working with survivors with disabilities. If the survivor discloses information that they do not wish to be shared with their caregiver, the case worker 20 must respect and maintain the survivor's confidentiality and not share information with the caregiver. When sharing information, always think about why the caregiver needs that information and only share what is necessary to facilitate support for the survivor. For example, you may do a joint session with a survivor and their caregiver to review a case action plan, because it requires the caregiver or family member's action. In that case, they only need to know what is relevant for facilitating that part of the survivor's care. 33

6.2 Fostering positive power dynamics 34

It is important to pay attention to the dynamic between the survivor and their caregiver. The following questions can assist case workers to better understand the power dynamics at play in the relationship between the survivor and caregiver:

Thinking through the perspectives and needs of both the survivor and the caregiver, and the intersections and relationships between each individual and the case worker, can help to shape the process of case management in a way that ensures that the needs of both individuals are met, and that their relationship is strengthened. Providing caregivers with accurate information about the risks and impacts GBV can help them understand what the survivor may be experiencing and how to best support them. Caregivers may be inclined to blame the survivor, so be sure to communicate that what happened was not the survivor's fault. Caregivers may also blame themselves for not being able to protect the survivor from violence. Providing messages to caregivers that are supportive, non-blaming and non-judgmental may be important for them to hear. By supporting them, the case worker is also enhancing their ability to support the survivor.

6.3 Identifying and responding to caregiver needs 35

Caregivers are people first and foremost with their own perspective, needs and feelings. Care-giving is a complex role, and caregivers may have conflicting feelings — they may feel guilty, resentful, angry, afraid, concerned, and as though they have failed. They may prioritize the person they are caring for above everything else, including themselves, which can be difficult for others in the household. They may also have unmet needs of their own, particularly if they carry the full responsibility for care with no one to support them. For female caregivers, caring for a person with disabilities comes in addition to the many other responsibilities and duties expected of them at home.

Caregivers are also exposed to the threat and reality of GBV, and case workers have to pay attention to their safety concerns and their opportunities to have more control over their lives. Caregivers are most often women and adolescent girls, meaning they already experience disadvantage within the household and community, and are likely over-burdened with domestic responsibilities, including the care of children and the elderly, and household chores. Caregiving can be a very isolating experience, and more so for women who are already less likely to have access to opportunities outside the home. This is also 21 an opportunity to talk about female caregivers’ own exposure to and risk of violence, including violence from the people they care for or domestic violence, and work with them to plan for safety and access to services.

Providing good support for caregivers is one of the most effective ways to improve the safety and well-being of those they care for. It may be useful to work separately with caregivers (in addition to working with survivors and caregivers together). This can serve a psychosocial intervention in and of itself by creating a safe space for caregivers to talk about the issues that affect them, their own emotions – positive and negative – without feeling that they are being demanding or selfish, or that they are not properly heard. It is also important to recognize that feelings about being a caregiver are complex, and it is normal to feel frustration, resentment and anger, along with love and concern. Helping caregivers to understand and manage these feelings can be very helpful in strengthening the core relationship between the caregiver and the person being cared for.

7. CASE ASSESSMENT AND ACTION PLANNING

Case workers should follow all standards steps as they facilitate disclosure, gather background information, and support survivors to access appropriate services and assistance. Critical steps in the case management process for survivors and at-risk women, children, and youth with disabilities are assessing their needs; identifying skills and capacities and using this in case action planning; identifying appropriate services and assistance; and assisting and advocating for survivors to receive quality services.

7.1 Assessing needs of survivors and at-risk women, children, and youth with disabilities

The causes of GBV against persons with disabilities are rooted in the inequalities and power imbalances between women and men, the inequalities associated with disability, and in many cases in Lebanon – the displacement of the individual or family from their country of origin. GBV case workers should consider the following factors when undertaking assessment and intake processes, as they may increase the vulnerability of persons with disabilities to GBV, and provide valuable information for case action planning:

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As described earlier, women, children, and youth with disabilities may face added attitudinal, physical / environmental, communication and policy or administrative barriers when accessing services and assistance.

It is important to discuss these barriers with the survivor, and identify appropriate strategies to address these, so that they will be able to access programs and services on an equal basis with others.

7.2 Identifying skills, capacities and strengths/assets

A core component of GBV case management is collaborating with survivors to identify strengths and assets, then building off these specific strengths in action planning – this same approach should also be applied to working with survivors with disabilities. The following general principles are important to remember when working to assess the skills, capacities and assets of a survivor:

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7.3 Identifying safety concerns and developing a safety plan

As emphasized in other sections of this guidance, case workers should follow all standard operating procedures for case management when working with survivors with disabilities, including when identifying safety concerns and developing safety plans. Survivors with disabilities may have specific 25 safety concerns to take into consideration when developing safety plans with them. Safety plans for survivors with disabilities must be highly individualized and should take into account the following:

7.4 Referral pathways for survivors with disabilities – Roles of different actors

In the case of survivors with disabilities, it is imperative, regardless of the type of disability of the survivor, that they have case management services provided by service providers who specialize in GBV. GBV case workers have a central role to play in identifying needs, discussing options with survivors, and then coordinating appropriate referral processes. GBV case workers should avoid deferring to disability-related needs first, as this engages a wider range of actors who are not necessarily able to respond to the survivor's needs relating to violence and may threaten confidentiality.

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ROLE OF DIFFEERENT ACTORS IN REFERRAL PATHWAYS FOR SURVIVORS WITH DISABILITES
ACTOR ROLES & RESPONSIBILITIES
GBV AGENCIES
GBV CASE WORKERS
DISABILITY SPECIFIC SERVICE PROVIDERS
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ORGANIZATIONS OF PERSONS WITH DISABILITES (DPOS)
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7.5 Advocating for survivors with disabilities

When working with survivors with disabilities, advocacy – speaking in support of survivors to access the care and services they need and want – often becomes an essential component in the case management process. GBV case workers will frequently need to play a role in educating service providers to ensure that survivors with disabilities are not turned away from services, and/or harmed by the interactions that they have with service providers. Based on the action plan developed, case workers may need to contact the relevant service providers to refer the survivor, explaining the adaptations required to address any barriers.

8. TIPS FOR COMMUNICATING WITH PERSONS WITH DISABILITIES

In most cases, persons with disabilities can communicate directly with staff with no adaptions, or relatively small adaptions. In other cases, it may be more difficult to determine the best way to communicate with the individual, and additional steps may be required. It is important when working with persons with disabilities that you take time to watch and listen. Each time you meet the person you will learn something new about them and understand better how they communicate and what they mean. 41

Below are some tips for frontline workers on ways to adapt verbal and non-verbal communication when interacting with persons with disabilities. 42

8.1 Use respectful language

Different language is used in different contexts to describe disability and to refer to persons with disabilities. Some words and terms may carry negative, disrespectful or discriminatory connotations and should be avoided in our communications. The Convention on the Rights of Persons with Disabilitiesis translated into many languages, including Arabic, and can be a useful guide to correct interpretation of different disability terms. 43

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Organizations of persons with disabilities (DPOs) can also provide guidance on the terminology preferred by persons with disabilities in a given country. Additionally, the national Lebanese Law 220/2000 can provide additional helpful guidance proper terminology.

DPO leaders in Lebanon have suggested the following terms to be the most respectful and most commonly accepted terms in Arabic:

Person with disability شخص ذو اعاقة
Person with physical disability شخص ذو إعاقة حركية
Person with intellectual disability الشخص ذو اعاقة ذهنية
Person with mental/psychosocial disability الشخص ذو اعاقة فكرية
Person with hearing impairment ذوي الإعاقة السمعية
Down syndrome تثلث الصبغية 21/ متلازمة داون
Autism التوحد
Person with autism الشخص ذو توحد
Support person الشخص الداعم
Person with visual impairment شخص لديه اعاقة بصرية،
Blind Person شخص كفيف أو مكفوف
Person with low vision شخص ضعيف البصر

The table below also has some suggestions on tips for ensuring respectful language:

AVOID…. CONSIDER USING…..

Emphasizing the impairment or condition before the person

For example: Disabled person

Focus on the person first, not their disability

For example: Person with disabilities

Negative language about disability

For example:

Instead use neutral language

For example:

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Referring to other people as “normal” or “healthy” Try using “persons without disabilities”

8.2 Use a strengths-based approach

Do not make assumptions about the skills and capacities of persons with disabilities – this can negatively affect the way we communicate and interact. Remember that persons with disabilities are people first and foremost. Just like all people, they have different opinions, skills and capacities. Look at what the person with a disability can do. This can often give us insight into how they can communicate and participate in your activities.

8.3 General guidance

Remember that you have many skills that you can use with persons with disabilities. Every day you are listening to, communicating with and supporting women, girls, boys and men who are all different in their own ways. All of us use speech, writing, pictures and posters, and activities, as well as emotions and gestures, to both convey and understand information. Different approaches may work better with each individual. Ask persons with disabilities and their caregivers for advice about their preferred communication method, and then try different things.

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9. SUPERVISION STRUCTURES: SUPPORTING GBV CASE WORKERS WITH COMPLEX CASES

Supervisors can play a critical role in ensuring the quality of care for survivors with disabilities. In complex cases where persons with disabilities are involved, supervisors should provide additional support case workers as needed. Supervisors should also be prepared to assist case workers as they navigate any complicated steps of the case management process, particularly as case workers are establishing informed consent with survivors with profound disabilities.

9.1 Caseload and Assignment System

Agencies are also strongly encouraged to consider disability when determining the complexity of cases and case assignments. Considering disability in case assignments is important to ensuring case workers who are working with survivors with disabilities have the time and capacity to provide quality care. The average time for each session could potentially double – particularly when working with a survivor with communication difficulties or those who are using sign language. Initial counseling sessions may also take longer with these survivors, as the processes of establishing effective communication, building trust, ensuring informed consent processes, and fostering their participation in decision making may move more slowly than in the case of survivors without disabilities.

9.2 Individual & Peer Supervision

In cases that involve persons with complex disabilities, it may be necessary for supervisors to provide ad hoc support to the case workers during the initial phases of the case management process – in addition to regular weekly supervision meetings. During both individual and peer supervision sessions, supervisors should provide ongoing opportunities for staff to reflect on their personal values, beliefs and behaviors and how these impact on their work with survivors with disabilities. Ensure standard group supervision sizes – no more than 6-7 case workers per group – so that there is ample time for peer 32 exchanges and learning. Encouraging case presentations relating to survivors with disabilities in peer supervision will provide opportunity for case workers to share ideas and strategies with each other.

Below are sample guiding questions that could be used in supervision with case workers:

9.3 Supervision Tools

In addition to the supervision strategies mentioned above, case management supervisors can also create or adapt existing tools to assess staff attitudes, knowledge and skills that are important for providing survivor-centered care and case management services to persons with disabilities.

Supervisors should assess attitudes of case workers on working with persons with disabilities. Supervisors can consider adding questions related to disability to the existing Survivor-Centered Attitude Scales, currently being used by many agencies to evaluate attitudes among staff providing direct support to survivors. Specific questions about survivors with disabilities and their caregivers can help the supervisor to assess a staff member's personal values and beliefs and to measure an individual's attitudinal readiness for working directly with survivors with disabilities, while also highlighting specific areas in which the staff member may require further education and training. See Tool 2: Case Worker Attitudes Relating to Disability and GBV for a list of questions that could be integrated into standard attitudinal questionnaires and tools.

Supervisors should also support case workers by providing experiential learning opportunities – creating space for them to practice using certain tools adapted to working with persons with disabilities – particularly tools related to seeking informed consent and establishing communication. Group discussions and participatory activities can also assist in reflective practices supporting case worker teams to identify and share positive changes in their knowledge, attitudes and practices relating to disability inclusion.

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10. GUIDANCE FOR GBV TRAINERS

GBV trainers should integrate disability into existing training for GBV staff, facilitating discussions on the needs and rights of women, girls and youth with disabilities. Incorporating an analysis of both gender inequality, as well as disability-based discrimination, will assist GBV staff to better understanding the unique factors that contribute to GBV risks and vulnerability for women, children and youth with disabilities, and to identify more effective strategies for inclusion in GBV programs. It is recommended that content about persons with disabilities and their caregivers be integrated and mainstreamed throughout core GBV training packages, including through case studies and examples centered on women, children and youth with disabilities. Over time, GBV staff will increasingly recognize that responding to the needs of persons with disabilities is a core part of their work and that they have the skills to effectively do this with in their jobs.

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Notes

1 World Health Organization & World Bank (2011) World Report on Disability. http://www.who.int/disabilities/world_report/2011/en/

2 Handicap International & HelpAge International (2014) Hidden Victims of the Syrian Crisis: Disabled, Injured and Older Refugees. http://d3n8a8pro7vhmx.cloudfront.net/handicapinternational/pages/454/attachments/original/1397045203/Hidden_Victims_of_the_Syrian_Crisis—disabled__injured_and_older_refugees.pdf?1397045203

3 This estimate is determined using a global estimate that 15% of any population will be persons with disabilities (WHO & World Bank, 2011), and that the population of Lebanon is approximately 6 million people (World Bank, 2016, https://data.worldbank.org/indicator/SP.POP.TOTL?locations=LB).

4 Women's Refugee Commission (2014) Disability inclusion: Translating policy into practice in humanitarian action. http://wrc.ms/disability-inclusion-translating-policy-into-practice

5 International Rescue Committee (2014) GBV emergency response and preparedness: Participant handbook, page 7. http://gbvresponders.org/wp-content/uploads/2014/04/GBV-ERP-Participant-Handbook-REVISED.pdf

6 Women's Refugee Commission & International Rescue Committee (2015) “I see that it is possible”: Building capacity for disability inclusion in gender-based violence programming in humanitarian settings. http://wrc.ms/i-see-that-it-is-possible

7 Government of Lebanon & the United Nations (2017) Lebanon Crisis Response Plan 2017-2020. http://www.3rpsyriacrisis.org/wp-content/uploads/2017/01/Lebanon-Crisis-Response-Plan-2017-2020.pdf

8 Building Resilience and Development Programme: The MoSA National Plan to Safeguard Children and Women in Lebanon 2014-2015.

9 Women's Refugee Commission & UNICEF (2017) Disability Inclusion in Child Protection and Gender-Based Violence Programs. Training Needs Assessment Report: Gender-Based Violence (GBV) Programs, November 2017.

10 Women's Refugee Commission & UNICEF (2017) Disability Inclusion in Child Protection and Gender-Based Violence Programs. Training Needs Assessment Report: Gender-Based Violence (GBV) Programs, November 2017.

11 UNHCR. (2011). Working with persons with disabilities in forced displacement. http://www.unhcr.org/publications/manuals/4ec3c81c9/working-persons-disabilities-forced-displacement.html

12 UNESCO (2013) Social Inclusion of Young Persons with Disabilities (PWD) in Lebanon. http://www.unesco.org/new/fileadmin/MULTIMEDIA/FIELD/Beirut/images/SHS/Social_Inclusion_Young_Persons_with_Disabilities_Lebanon.pdf

13 The United Nations (2006) Convention on the Rights of Persons with Disabilities. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html

14 World Health Organization (n.d.) Health Topic: Disabilities. http://www.who.int/topics/disabilities/en/

15 Interagency Gender-Based Violence Case Management Guidelines: Providing Care and Case Management Services to Gender-Based Violence Survivors in Humanitarian Settings. (2017) https://reliefweb.int/sites/reliefweb.int/files/resources/interagency-gbv-case-management-guidelines_final_2017_low-res.pdf

16 Women's Refugee Commission (2013). Disability Inclusion in the Syrian Refugee Response in Lebanon. http://wrc.ms/disability-inclusion-syrian-refugees

17 The United Nations (2006) Convention on the Rights of Persons with Disabilities. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html

18 World Health Organization & World Bank (2011) World Report on Disability. http://www.who.int/disabilities/world_report/2011/en/

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19 The United Nations (2006) Convention on the Rights of Persons with Disabilities. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html

20 World Health Organization & World Bank (2011) World Report on Disability. http://www.who.int/disabilities/world_report/2011/en/

21 Inter-Agency Standard Operating Procedures (SOPs) for SGBV Prevention and Response in Lebanon.

22 Interagency Gender-Based Violence Case Management Guidelines: Providing Care and Case Management Services to Gender-Based Violence Survivors in Humanitarian Settings. (2017) https://reliefweb.int/sites/reliefweb.int/files/resources/interagency-gbv-case-management-guidelines_final_2017_low-res.pdf

23 Interagency Gender-Based Violence Case Management Guidelines: Providing Care and Case Management Services to Gender-Based Violence Survivors in Humanitarian Settings. (2017) https://reliefweb.int/sites/reliefweb.int/files/resources/interagency-gbv-case-management-guidelines_final_2017_low-res.pdf

24 The United Nations (2006) Convention on the Rights of Persons with Disabilities. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html

25 The United Nations (2014) Convention on the Rights of Persons with Disabilities General Comment 1. Article 12: Equal recognition before the law. https://documents-dds-ny.un.org/doc/UNDOC/GEN/G14/031/20/PDF/G1403120.pdf?OpenElement

26 Adapted from: Consent and people with intellectual disabilities: The basics. http://www.intellectualdisability.info/how-to../consent-and-people-with-intellectual-disabilities-the-basics

27 Inter-Agency Standard Operating Procedures (SOPs) for SGBV Prevention and Response in Lebanon (2014).

28 Adapted from: Consent and people with intellectual disabilities: The basics. http://www.intellectualdisability.info/how-to-guides/articles/consent-and-people-with-intellectual-disabilities-the-basics. WRC & IRC (2015) Tool 9: Guidance for GBV Service Providers: Informed Consent Process with Adult Survivors with Disabilities. https://www.womensrefugeecommission.org/component/zdocs/document/download/1161

29 Women's Refugee Commission & International Rescue Committee (2015) Building Capacity for Disability Inclusion in GBV Programming in Humanitarian Settings: A Toolkit for GBV Practitioners. http://wrc.ms/iseethatitispossible-gbv-toolkit

30 Consent and people with intellectual disabilities: The basics. http://www.intellectualdisability.info/how-to../consent-and-people-with-intellectual-disabilities-the-basics

31 The United Nations (2006) Convention on the Rights of Persons with Disabilities. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html

32 Women's Refugee Commission & International Rescue Committee (2015) Building Capacity for Disability Inclusion in GBV Programming in Humanitarian Settings: A Toolkit for GBV Practitioners http://wrc.ms/iseethatitispossible-gbv-toolkit

33 Interagency Gender-Based Violence Case Management Guidelines: Providing Care and Case Management Services to Gender-Based Violence Survivors in Humanitarian Settings. (2017) https://reliefweb.int/sites/reliefweb.int/files/resources/interagency-gbv-case-management-guidelines_final_2017_low-res.pdf

34 Women's Refugee Commission & International Rescue Committee (2015) Building Capacity for Disability Inclusion in GBV Programming in Humanitarian Settings: A Toolkit for GBV Practitioners http://wrc.ms/iseethatitispossible-gbv-toolkit

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35 Women's Refugee Commission & International Rescue Committee (2015) Building Capacity for Disability Inclusion in GBV Programming in Humanitarian Settings: A Toolkit for GBV Practitioners http://wrc.ms/iseethatitispossible-gbv-toolkit

36 Women's Refugee Commission & International Rescue Committee (2015) “I see that it is possible”: Building capacity for disability inclusion in gender-based violence programming in humanitarian settings. http://wrc.ms/i-see-that-it-is-possible

37 Wisconsin Coalition Against Domestic Violence (n.d.) Power and Control Wheel: Persons with Disabilities and their Caregivers. http://www.springtideresources.org/sites/all/files/People_with_Disabilties_and_Caregivers_Wheel.pdf

38 Women's Refugee Commission & International Rescue Committee (2015) “I see that it is possible”: Building capacity for disability inclusion in gender-based violence programming in humanitarian settings. http://wrc.ms/i-see-that-it-is-possible

39 Women's Refugee Commission & International Rescue Committee (2015) Building Capacity for Disability Inclusion in GBV Programming in Humanitarian Settings: A Toolkit for GBV Practitioners http://wrc.ms/iseethatitispossible-gbv-toolkit

40 Interagency Gender-Based Violence Case Management Guidelines: Providing Care and Case Management Services to Gender-Based Violence Survivors in Humanitarian Settings. (2017) https://reliefweb.int/sites/reliefweb.int/files/resources/interagency-gbv-case-management-guidelines_final_2017_low-res.pdf

41 Women's Refugee Commission & International Rescue Committee (2015) Building Capacity for Disability Inclusion in GBV Programming in Humanitarian Settings: A Toolkit for GBV Practitioners. http://wrc.ms/iseethatitispossible-gbv-toolkit

42 Women's Refugee Commission & International Rescue Committee (2015) Building Capacity for Disability Inclusion in GBV Programming in Humanitarian Settings: A Toolkit for GBV Practitioners. http://wrc.ms/iseethatitispossible-gbv-toolkit

43 The United Nations (2006) Convention on the Rights of Persons with Disabilities (Arabic). http://www.un.org/disabilities/documents/convention/convoptprot-a.pdf