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Childhood, Disability & Violence
Empowering disability organisations to develop prevention strategies
Index
Introduction p. 5
||| Why has this booklet been written?
||| Who is this booklet addressed to?
||| How can the booklet be used?
1. Domestic violence p. 7
||| Definitions of domestic violence
||| Different types of child maltreatment
||| Violence is a negation of children's fundamental rights
||| Domestic violence and children with disabilities
||| Forms of violence specifically related to disability
2. Understanding the problem p. 11
||| Theories of maltreatment
||| How to detect child maltreatment
||| Focusing on disability
3. Prevention p. 17
||| Definition and levels of prevention
||| Forms of prevention
||| Cornerstones for prevention strategies
Sources p. 22
Note to the reader
For further consultation
Bibliography
Appendix 1 p. 23
Risk factors
Protective factors
Appendix 2 p. 24
Indicators of child maltreatment
Project team responsible for the text of this publication:
Melissa Filippini & Evert-Jan Hoogerwerf (AIAS)
Susana Lució & Ana Rodrigues (Fenacerci)
Cristina Diaz & Ana Royo Salas (DFA)
Georgia Fyca (Disability Now)
Design: Miranda Di Pietro
Illustrations: Sara H.
Published in five different language editions
with financial support from the European
Commission under the DAPHNE Programme.
Italian, Portuguese, Greek and Spanish ver-
sions of this booklet can be obtained by writ-
ing directly to the partner organisations.
The content of this booklet reflects the view of
the authors.
The European Commission is not liable for
any use that may be made of the information
contained in it.
©Copyright AIAS Bologna onlus, on behalf of
the partnership, 2004.
Childhood, Disability & Violence
AIAS BOLOGNA ONLUS, Via Ferrara 32, 40139 Bologna, Italy. info@aiasbo.it. www.aiasbo.it
FENACERCI, Rua Augusto Macedo 2A, 1600-794 Lisboa, Portugal. fenacerci@fenacerci.pt. www.fenacerci.pt
DISMINUIDOS FÍSICOS DE ARAGÓN, José Luis Pomarón 9, 50008 Zaragoza, Spain. dfa@dfa-org.com. www.dfa-org.com
DISABILITY NOW, 3rd Septevriou 30, 54636 Thessaloniki, Greece. info@disabled.gr. www.disabled.gr
5
Introduction
||| Why has this booklet been written? ||| Who is this booklet
addressed to? ||| How can the booklet be used?
Why has this booklet
been written?
Domestic violence is a worldwide problem that involves every section
of the population. It can be found in all socio-economic, religious, cul-
tural, racial and ethnic groups. It is acknowledged as a significant
social problem and fortunately in recent years greater attention has
been devoted to the victims of domestic violence, in particular where
it affects children. Nevertheless little is known about violence against
children with disabilities. Maltreatment of children with disabilities can
be considered as a taboo within a taboo, probably because the asso-
ciation between disability and violence is emotionally difficult to cope
with.
Violence in families of children with disabilities is difficult to trace and
to prevent. Too little accurate epidemiological data is available for us
to have a clear idea of the incidence of domestic maltreatment involv-
ing these children, although what is available indicates a higher risk
for certain groups.
In addition to the damage caused to the victims, the problem of child
maltreatment has important social implications. Society as a whole
must consider itself responsible for preventing it at all different levels,
from an individual and family level to communities and institutions. If
this is true for all children, it is especially true for children with dis-
abilities, who generally speaking are even more vulnerable. To achieve
this shared responsibility, the weight and the nature of the problem
have to be acknowledged, recognised and understood.
The aim of this booklet is to raise awareness levels regarding the
4
importance of the issue of domestic violence against children with
disabilities. It further aims to correctly inform the reader on the com-
plexity of the issues at stake, while avoiding branding the families as
criminals. It does so by presenting important concepts and knowl-
edge about violence against children with disabilities, in the form of
definitions, explanatory models and indicators of violence. Finally the
booklet intends to promote prevention, by providing “cornerstones”
for the development of prevention strategies. The booklet provides
concrete examples to illustrate the key concepts.
Who is this booklet
addressed to?
Although the issue of maltreatment of children with disabilities
regards the whole of society, and public institutions have a specific
responsibility in the matter, the authors believe that local associations
representing families or people with disabilities, social co-operatives
and other NGOs in the field of disability have an important and spe-
cific role in defining, understanding, analysing and preventing vio-
lence against children with disabilities. This booklet, therefore, has
been written principally, though not exclusively, for them.
These organisations can claim to make a specific contribution in the
fight against child maltreatment through the direct and daily contacts
that they have with families and children, which allow them to closely
observe the family structure, the internal and external network sur-
rounding the child, the psychological and emotional background, the
quality of care and assistance and the implementation of supportive
and protective laws and regulations. Many of these organisations
have first hand knowledge of examples of maltreatment, but few have
developed a systematic approach to prevention and intervention.
Their ability to “listen”, to identify situations at risk and to prevent mal-
treatment must expand, naturally in close collaboration with the insti-
tutional network supporting the families. In fact the booklet affirms that
only co-ordinated and integrated networks sharing a common lan-
guage and objectives can hope to be successful in prevention.
How can the booklet be used?
The booklet aims to place the issue of violence against children with
disabilities high on the agenda of organisations in the field of disabil-
ity. It should motivate and support people within those organisations
to raise the issues internally and externally, communicating the con-
tent to public and private institutions.
In addition the booklet provides cornerstones for developing preven-
tion strategies. Knowing the “whys” and the “hows” of the prevention
of violence against children with disabilities means creating the basis
for proper interventions to prevent dramatic situations from erupting
into violent acts.
The booklet has been written by organisations working in differing
social and cultural contexts across Europe. Nevertheless the authors
believe the content to be universally valid, although any actions under-
taken will require mediation with the local social, institutional and cul-
tural context.
7
Domestic violence
||| Definitions of domestic violence ||| Different types of child
maltreatment ||| Violence is a negation of children’s
fundamental rights ||| Domestic violence and children with
disabilities ||| Forms of violence specifically related to disability
1
section
6
Definitions of domestic violence
Domestic or family violence refers to deliberate harm, intimidation or coercion in the
domestic context of a close relationship. It might involve all family members, men, women
and children, both as perpetrators and as victims.
Child maltreatment is harm (or risk of harm) caused to a child by a parent, caregiver, or
any other person responsible for the child’s safety. Therefore domestic violence against
children also includes violence inflicted on them by external family caregivers such as
baby sitters and educators, and in addition includes violence inflicted on children living
permanently in institutes.
For the authors the concept of “domestic” not only has a physical significance (home,
family), but also an emotional significance, referring to the most intimate and safest
sphere of life a child can expect to find. For this reason domestic violence is more diffi-
cult to cope with than violence experienced in other spheres of life, or at least it is for a
child.
Different types of child maltreatment
The World Health Organisation distinguishes five subtypes of child maltreatment:
Physical abuse of a child is that which results in actual or potential physical harm from
an interaction or lack of interaction, which is reasonably within the control of a parent or
person in a position of responsibility, power, or trust. There may be single or repeated
incidents.
Child sexual abuse is the involvement of a child in sexual activity that he or she does not
fully comprehend, is unable to give informed consent to, or for which the child is not
developmentally prepared and cannot give consent, or that violate the laws or social
taboos of society. Child sexual abuse is evidenced by an activity between a child and an
adult or another child who by age or development is in a relationship of responsibility,
||| Introduction
Domestic violence
and children with disabilities
It is difficult to find reliable studies on the incidence of violence against children with dis-
abilities. Wherever data is available, mainly from American sources, it is difficult to com-
pare because of the many variables involved: namely, researched population, classifica-
tion of disabilities, cultural and legislative background, general attitude towards the
problem, and so on. Although essential to develop a systematic study of violence against
children with disabilities in each single European country in order to collect valid local
data on the extent and consequences of violence against children with disabilities, there
is sufficient evidence to state that children with disabilities are more at risk of experi-
encing domestic violence then children without disabilities (2).
When the child is the victim of violence,
there will be different consequences.
Children’s risk levels and reactions to
domestic violence exist on a continuum;
some children demonstrate enormous
resilience, while others show signs of
significant maladaptive adjustment. The
same is true for children with disabili-
ties.
Childhood problems associated with
exposure to domestic violence fall into
three primary categories:
• behavioural, social, and emotional
problems (e.g. disobedience, hostility,
anger, fear, anxiety, depression, poor
sibling and social relationships);
• cognitive and attitude problems (e.g.
lower cognitive functioning, poor school
performance, pro-violence attitudes,
lack of conflict resolution skills);
• long-term problems (e.g. higher levels
of adult depression and trauma
symptoms).
In general terms, the younger the age,
the more devastating will be the impact
of the abuse, due also to the fact that exposure to violence might continue for a signif-
icant period before being detected. In addition children with poor coping skills and few
opportunities to socialise and communicate are more likely to experience problems than
children with strong coping skills and supportive social networks. Therefore appropriate
support for victims of violence will necessarily have to take into account the type of dis-
ability and how this disability is associated with personal resources and context factors,
including the availability of specialised professionals (Elisa).
Finally, the connection between violence and disability works in two directions. Not only
are children with disability more exposed to violence, but violence is also a significant
cause of intellectual and other disabilities (3). The high rates of violence experienced by
people with intellectual disabilities result partly from the fact that violence causes dis-
abilities and partly from society’s response to disabilities, which often increases the risk
of violence.
trust or power, the activity being intended to gratify or satisfy the needs of the other per-
son. This may included but not is limited to the inducement or coercion of a child to
engage in any unlawful sexual activity; the exploitative use of a child in prostitution or
other unlawful sexual practices; the exploitative use of children in pornographic per-
formances and materials.
Neglect and negligent treatment is the inattention or omission on the part of the care-
giver to provide for the development of the child in all spheres: health, education, emo-
tional development, nutrition, shelter and safe living conditions, in the context of
resources reasonably available to the family or caretakers and causes, or has a high
probability of causing harm to the child’s health or physical, mental, spiritual, moral or
social development. This includes the failure to properly supervise and protect children
from harm as much as is feasible.
Emotional abuse includes the failure to provide a developmentally appropriate, support-
ive environment, including the availability of a primary attachment figure, so that the child
can develop a stable and full range of emotional and social competencies commensu-
rate with her or his personal potential, and in the context of the society in which the child
dwells. There may also be acts toward the child that cause or have a high probability of
causing harm to the child’s health or physical, mental, spiritual, moral or social develop-
ment. These acts must be reasonably within the control of the parent or person in a rela-
tionship of responsibility, trust or power. Acts include restriction of movement, patterns
of belittling, denigrating, scape-goating, threatening, scaring, discriminating, ridiculing,
or other non-physical forms of hostile or rejecting treatment (1).
Commercial or other exploitation of a child refers to use of the child in work or other
activities for the benefit of others. This includes, but is not limited to, child labour and
child prostitution. These activities are to the detriment of the child’s physical or mental
health, education, moral or social-emotional development.
Violence is a negation
of children’s fundamental rights
Violence is a broad term which includes many different types of non verbal and verbal
acts and thoughts. The right perspective for any understanding of the issue is to con-
sider violence above all as a negation of the child’s rights.
The UN Convention on the Rights of the Child, which entered into force in 1990, states
in article 19 that all countries “shall take appropriate legislative, administrative, social
and educational measures to protect the child from all forms of physical or mental vio-
lence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation,
including sexual abuse, while in the care of parents, legal guardians or any other person
who has the care of the child. Such protective measures should, as appropriate, include
effective procedures for the establishment of social programmes to provide necessary
support for the child and for those who have the care of the child, as well as for other
forms of prevention and identification, reporting, referral, investigation, treatment and fol-
low-up instances of child maltreatment”.
A very powerful article that represents both an appeal and a yardstick for policy devel-
opment.
9
Section 1 ||| Domestic Violence
8
Section 1 ||| Domestic Violence
1. The Diagnostic and
Statistical Manual of Mental
Disorders 4th ed. (American
Psychiatric Association, 1994)
considers the Munchausen
Syndrome by proxy as a form
of child abuse or neglect
(MSBP). This is a psychiatric
disorder which causes an
individual, typically a mother, to
intentionally induce real or
apparent symptoms of a
disease in her child. The
disorder most commonly affects
children from birth to the age
of eight. Parents with MSBP
may simply exaggerate or
invent their child’s symptoms,
or they may deliberately induce
symptoms through various
methods, including poisoning,
suffocation, starvation, or
infecting the child’s blood.
Children are frequently made to
suffer with unnecessary tests,
surgery, or other invasive
procedures.
2. Some researchers have
found that children with
disabilities are 3.7 times as
likely to experience neglect,
3.8 times as likely to
experience physical and
emotional abuse, and 4 times
as likely to be sexually abused
(Sullivan and Knutson
2000/a). Other researches
point out that children with
mental disabilities run a
higher risk of being the
victims of all forms of violence
than children with physical
disabilities. An introduction to
the available scientific
literature is included in the
full project report, available on
www.aiasbo.it/daphne.
3. Sobsey (2002),
suggests that neurological
disabilities arising from
shaken-infant syndrome only
become apparent a year or
more after discharge from
hospital. Bonier et al. (1995),
have shown how the extreme
stress associated with violence
can produce biochemical
changes that damage both the
brain's structure and its
function.
Elisa is affected by Down Syndrome.
Elisa is 44 when she has her first contact
with Maria, a Social Services educator. On
meeting her, Maria is struck by Elisa’s
introvert character and shy personality. In
stark contrast, however, her behaviour
towards her father is excessively uninhibited as she embraces him
and kisses him passionately. When taking part in an open air
recreational activity a year after the death of her mother, Elisa
declares that she had sex with her father during her teens. Over the
course of a number of conversations between Elisa and Maria, further
details are revealed. Maria does not insist on hearing the whole truth
at once, so that she can leave time for Elisa and herself to elaborate
the emotions caused by the reconstruction of this part of Elisa’s
memories from her youth. Elisa states that Maria is the first person to
know about this abuse. It slowly becomes clear to Maria what the
causes of Elisa’s sleep disturbances are ; Elisa is afraid of the night
since it was at night that her father abused her. Apparently no
physical violence was inflicted on Elisa by her father as she shows no
sign of anger, regret or disgust. Nevertheless she is convinced she
has done something “unallowed”. Apparently her mother and brothers
were not aware of what was going on. Maria, the educator, has great
difficulty being able to cope. She contacts her superior at the service
she works for and together they decide to consult a psychologist, in
order to assist both Elisa and herself.
Forms of violence
specifically related to disability
There are specific forms of violence that typically see children with disabilities as victims
but that are hard to detect or to recognise as such.
At a family level the non acceptance of the
disability or the unrealistic expectations
that parents have concerning rehabilita-
tion can cause therapeutic obstinacy
inflicted on children (Tommaso). The
improper use of pharmacological treat-
ment or the denial of appropriate health
assistance (for instance dental care) can
also be considered forms of violence.
Maternal risk behaviour during pregnancy,
for example drug or alcohol abuse, is a
form of prenatal violence that may cause
severe disabilities
There are specific forms of violence related to disability caused by complex individual
social and cultural convictions, which are strictly inter related and worked out at differ-
ent levels. They are the expression of attitudes which are particularly difficult to detect
and change as they are culturally determined and widely accepted. Some examples are
the lack of early intervention aiming at autonomy and independence, including access to
assistive technology, the denial of a sexual identity to children with disabilities, the lack
of self determination and decision making power, the lack of communication opportuni-
ties and the lack of privacy for adolescents and adults with disabilities.
Negative attitudes towards diversity and disability are expressed by many people
through open discrimination. Humiliation, fear of physical contact and disdain, are forms
of violence that often see children with disabilities as victims.
Many people with disabilities will argue that the lack of equal opportunities in all realms
of life has violent effects on their lives. The barriers that obstruct people with disabilities
from having access to opportunities are both physical and mental.
Theories of maltreatment
Many causal theories have been elaborated to explain the phe-
nomenon of maltreatment of children. First explanatory models
suggested a direct cause-effect relationship between individual
psychological characteristics or socio-economic factors and
the occurrence of violence.
Over the years, the debate has evolved into models which
recognise the interdependence or interaction of multiple causal
agents. Maltreatment of children with disabilities is a complex
problem. There is no single known cause of child maltreatment,
nor is there any single description that covers all those families
in which children are victims.
The ecological model
An ecological model may be useful in helping to understand the
causes and development of violence. This type of model dis-
cusses the factors that contribute to maltreatment including
socio-cultural factors, parent and/or child characteristics and
triggering situations that serve as a catalyst for maltreatment
events. It considers predisposing factors (individual, family,
social, cultural); mediating factors (social support networks);
breaking out factors (life cycle events, event perceptions and
interpretations and the power to stress these events exert on
parents and family) (George).
11
Understanding the problem
||| Theories of maltreatment ||| How to detect child
maltreatment ||| Focusing on disability
2
section
10
Section 1 ||| Domestic Violence
Tommaso is a 13 year old boy,
who is affected by cerebral palsy. He is
also severely mentally retarded and suffers
from severe hypo-vision. He can neither
speak nor walk. His father has not
accepted his disability and has unrealistic
expectations about his possibilities of improvement. Home care
assistants report that he forces them to stimulate Tommaso many
times a day with visual, auditory and tactile stimuli, which makes
him cry. The father drags Tommaso to make him crawl on a
mattress: since he is unable to move, he has abrasions at the
base of his neck. When Tommaso sees his father, he turns rigid.
George was
born in 1964.
Three days after his
birth he contracted
polio, since when
he has been
physically disabled and uses a wheelchair to
get about. His parents moved to Athens a
few years before he was born. His father was
a farmer and his mother was a housewife.
His father came from a very traditional family
where women were not allowed to work and
had to stay at home with the children. As an
adult, George reveals that he encountered
psychological and physical violence from his
father. His father would frequently insult him
using words such as "useless" and "cripple".
His mother was, on the contrary, very
affectionate and protective, but unfortunately
was always under her husband's supervision
and was unable to take any decisions.
George's family was very patriarchal, a family
model which still exists in some parts of
Greece.
Protective factors
In the assessment and analysis of a situation
both risk factors and protective factors
have to be considered.
Protective factors refer to the strengths
and resources that appear to mediate or
serve as a “buffer” against risk factors,
promoting resilience against the negative
effects of maltreatment experiences.
In general, research has found that sup-
portive, emotionally satisfying relation-
ships with a network of relatives or friends
can help minimise the risk of parents mal-
treating children, especially during stress-
ful events. On the other hand, apparently
harmonious family and socio-economic
situations might lower the level of atten-
tion and alertness of external observers
such as friends, relatives and social serv-
ices (Maria).
In the same way as risk factors, protective
factors associated with child maltreatment
can also refer to different groups: parent
or caregiver factors, family factors, child
factors, environmental factors. For a com-
plete list of risk factors see Appendix 1.
How to detect child maltreatment
Recognising the signs and the symptoms of child maltreatment is difficult, and is even
more so in children with disabilities. They are often unable to express in words that they
have been abused or they can not understand that what has happened to them was
wrong. Signal symptoms of maltreatment in children with disabilities are often misun-
derstood, misinterpreted or ignored (Teresa).
Diagnosing maltreatment requires a high
level of suspicion and a number of definite
signals. There are:
• child physical indicators which refer to
physical lesions, hygiene, nutrition and
appearance
• child behavioural indicators which refer
to behavioural characteristics and child
personality traits
• parental indicators which refer to behav-
iour, language and attitudes.
The ecological model acknowledges that
certain child characteristics can play a role
in maltreatment, particularly in families and
environments already at risk , but moves
away from considering disability per se as
a risk factor for maltreatment (Leonor).
Risk factors
Since no specific cause has been clearly
identified to explain maltreatment of chil-
dren with disability, researchers have
recognised a number of risk factors com-
monly associated with maltreatment.
• Risk factors predict a high likelihood of
violence.
• Risk factors occur on multiple levels
ranging from biological and individual-
level factors, to social level risks.
No single risk factor is in itself sufficient to
predict a person being abused or becom-
ing an abuser, but the greater the number
of risk factors associated with disability,
the greater will be the possibility of mal-
treatment (Abel). However, this does not
mean that the presence of these factors
will always result in child maltreatment.
Risk factors associated with child mal-
treatment can be collected together in
four groups: parent or caregiver factors,
family factors, child factors, environmental
factors. For a complete list of risk factors
see Appendix 1.
Talking about child factors does not mean
that children are responsible for maltreat-
ment. Certain factors, however, can make
some children more vulnerable to mal-
treating behaviour, depending on the inter-
actions of these characteristics with the
other factors reported above (4).
13
Section 2 ||| Understanding the problem
12
Section 2 ||| Understanding the problem
4. Sullivan and Knutson
(2000/b), have found in their
research population that
compared to other groups,
maltreated children with
disabilities experience the
largest number of additional
family stress factors. Generally
speaking, children with
disabilities tend to be
maltreated at a younger age.
In addition, there is a
significant association
between the family status of
the perpetrators and the type
of maltreatment. Immediate
family members account for
the vast majority of cases of
neglect and physical and
emotional abuse, whereas
among the perpetrators of
sexual abuse, non family
perpetrators are significantly
higher in number. Sobsey
(1997) affirms that children
with disabilities are frequently
dehumanised: the
depersonalisation of potential
victims is a key to removing
the inhibition of violence
against them. Social and
professional attitudes and
behaviour may transmit some
ideas of devaluation that put
children at risk. Sobsey (1994)
explains that prompt medical
intervention in neonatal care
units may interfere with
opportunities for interaction
and contact between parents
and their disabled children,
threatening the establishment
of attachment and bonding
between the child and his/her
parents, thus increasing the
risk of abuse for these
children.
Leonor was born in 1988 and was
diagnosed as suffering from Global
Development Delay and Epilepsy. Her
father was a craftsman with a criminal
record. As far as is known, her mother
was a prostitute. She had 9 children, 3 of
whom died as a result of extreme negligence. The father was in
the habit of drinking heavily and often hit all the members of the
family. When Leonor was 5 the mother left home taking some of
the children with her, but leaving her behind. Hospital records
indicate that Leonor showed signs of physical violence and sexual
abuse. Leonor lived for certain periods of time with her paternal
uncle and aunt and here too showed signs of physical violence
and sexual abuse. The child's basic needs were also neglected.
At the age of 10, she was admitted to an institution since when
her behaviour has become more stable. She is very affectionate
and sociable and at present has a boyfriend and mixes well with
other people.
Abel was born in 1985. He has a left
hemi-paresis, limited intellect, personality
disorder and epilepsy. He has not been
very fortunate in life. His mother Antonia
had a difficult youth, very little education
and a problematic relationship with her
parents, who did not accept that she lived with a man without
being married. When she became pregnant her partner did not
want to face up to the new situation and abandoned her. Abel's
father never acknowledged or met him. After Abel's birth Antonia
moved back to her parent's home, but frequently left the child with
his grandparents and her brother who was a regular drug and
alcohol user. She would stay away for days without giving any
explanation. Just before his fifth birthday, Abel injured an arm and
was taken to the first aid unit. The doctors informed the police and
minor protection service of the injury and they concluded that
Abel had been maltreated.
Maria was born in 1969. She was 2
years old when she was diagnosed with
cerebral palsy. Her parents came from
prosperous families and they had inherited
a considerable fortune from their parents.
They were leading a happy life and were
well integrated and appreciated socially. When Maria was 6 years
old her father died suddenly. Her mother's behaviour towards her
changed completely and she started accusing Maria of her
husband's death and blaming her disability as the cause. She
started drinking and frequently left Maria alone for days on end,
when she was unable to get out of bed to reach food. Maria was
15 years old before her relatives and friends of the family realised
what was really happening in her home. Up to that time everybody
believed that Maria's mother was taking proper care of her.
Teresa suffered from an attack of
polio at a very early age, but with the
support of her family, she recovered from
the illness, which, however, left her with
serious physical problems. In spite of these
lesions, her life as a child was normal. She
was loved by her parents and sisters and was successful at
school. Unfortunately, Teresa's father fell ill so her aunt and uncle
took care of her more frequently. Her father died a few years later,
the family's financial situation worsened and the mother was forced
to go out and work long hours in order to make ends meet.
Teresa's two sisters had to start working at an early age, but as
Teresa was a very good student she went on with her studies. She
became very introverted but as she was very responsible nobody
suspected that anything untoward was happening. Over the course
of time, she became seized by profound sadness. Her family
thought it likely that this was due to her disability.
Focusing on disability
Disability per se does not cause violence, but undoubtedly increases the risk.
According to the ecological model, risk and protective factors represent data which is
non static, but which enters a dynamic process with breaking out factors (i.e. a sudden
life event that demands a high level of adaptation) and which may act as a catalyst for
maltreatment. It is as if a delicate balance is suddenly disrupted.
Children with disabilities are children with special needs. Feeling full responsibility for
responding to these needs on a daily basis may lead to stressful situations and too much
stress may lead to violence.
Being the parents of a child with disabilities requires immense coping skills and abilities
to be able to adapt to countless new and adverse situations. The birth of a child with a
disability causes a trauma which demands profound reorganisation of both expectations
and future perspectives. Parents immediately have to find the strength both to react to
the shock and to arrange a new life.
Taking care of the child, the rest of the family and having to go to work in many cases
turns out to be incompatible. Therefore many main care givers, who in the majority of
cases are women, leave their jobs, which leads to the family becoming impoverished
and the couple splitting up into two distinctly separate specialist roles. One is home cen-
tred and concentrates on the provision of care while the other involves being out of the
house and is fundamentally concerned with providing income. Both roles demand dif-
ferent types of priorities and develop different types of stress which are not always easy
to mediate.
Another important change is that repre-
sented by the activation of a formal net-
work comprising social and health servic-
es, and an informal network made up of
relatives and friends. The more solid these
networks, the better protected the child
will be. Adequate networks will guarantee
the family both material and psychological
resources and thus the opportunity to
achieve and maintain a good quality of
care and life. In these cases, both the par-
ents’ abilities to cope with situations and
also their positive expectations will be
reinforced. When support is offered late
and there is poor communication with the
parents, intervention will be less success-
ful (Andreas).
A family member’s disability is a risk factor
which interacts with others. The weight of
risk factors on a situation is not absolute,
but is counterbalanced by that of protec-
tive factors. The result is a complex pattern of factors, the characteristics, internal mech-
anisms and processes of which are not always simple to detect and to understand.
Mapping them can be of help to identify high risk situations, but should never lead to
simple and linear conclusions.
The different types of maltreatment indicators can make the detection of violence against
children more precise and objective, although some indicators of maltreatment are also
symptoms of specific pathologies and disabilities (i.e. hyperactivity, behaviour disorders
and so on).
Maltreatment detection is often a process which requires time, particularly in cases of
disability. The observation of the child with disability has to be prolonged and carried out
both in family and non family environments. Only by analysing data collected at different
moments and in different contexts, can it be assumed that maltreatment has occurred or
is occurring.
For a list of possible indicators of child maltreatment, refer to Appendix 2.
15
Section 2 ||| Understanding the problem
14
Section 2 ||| Understanding the problem
When Teresa was 19 she took the
irrevocable decision to leave home and go
and live in another city. At 29, however,
she decided to return to her home town.
She joined a disability association in order
to form new relationships and look for a
new job. It was here that she met the people to whom she told
what had happened to her during her childhood. Teresa had been
sexually abused by her uncle from the age of 4 to 14, which had
affected her profoundly. This sexual abuse was interrupted when
she was in plaster but when the treatment finished she was
sexually harassed again and it was then that she decided to leave
home. Her family thought her sorrow, anxiety, introversion and the
other symptomatic manifestations she showed were due to her
disability, but were in fact the result of the sexual abuse she had
suffered and nobody suspected anything. The disability disguised
the causes of her behaviour and hid signs that in another case
might have been evident.
Andreas was born in 1990 with
jaundice and spastic quadriplegia. One
year before Andreas' birth, his parents
returned to Greece and found difficulty
fitting into their new community. When
Andreas was born his mother was facing
psychological problems. When he was 15 years old, his parents
divorced and the father-child relationship was interrupted. Andreas
was left with neither rehabilitation nor school education and his
sister was the only one who took care of him. Due to a lack of
medical assistance he was becoming weaker and weaker,
therefore the doctors decided to refer his case to the social
services. A social worker started visiting Andreas at home, but his
mother kept avoiding these meetings. She always refused the help
offered by the social services and Andreas' condition did not
improve. Finally, the court ordered that Andreas and his sister
should be removed from the custody of their mother and that they
should be placed in the care of an institution. should be placed in
the care of an institution.
17
Prevention
||| Definition and levels of prevention ||| Forms of prevention
||| Cornerstones for prevention strategies
3
section
16
Definition and levels of prevention
It is difficult to give an overall definition of prevention. Prevention is normally defined in
relation to the timing of the intervention, to the target group and the principle aims.
Generally speaking we can distinguish three levels:
primary level: prevention that attempts to stop the occurrence of violence by address-
ing issues which affect the entire population. It requires on-going attention. Primary pre-
vention may modify or enhance social cognitive processes such as problem-solving
skills, moral reasoning, generation of alternative solutions, shifting normative beliefs and
attitudes towards aggression and physical punishment.
Examples of prevention at a primary level of interest for this booklet are:
– Adequate legislation
– Efficient social services
– Public awareness activities (!)
– Community education programmes targeting all adults and children
– Civil rights education, including the UN Convention of the Rights of the Child.
secondary level: prevention efforts that aim to protect specific target groups.
Examples of prevention at secondary level of interest for this booklet are:
– Peri-natal and on-going identification of children and families “at risk”
– Substance abuse treatment programmes
– Community based and family centred support, assistance and networks
– Pre-natal, peri-natal and early childhood health care improving pregnancy outcomes
and strengthening early attachment
– Promoting good parental practices
– School based activities towards non violence
– Personal safety and protective behaviour education for children
!The Community
Development Association in
Aragon Areas, the University
of Zaragoza and the Social
Affairs Ministry and the Social
Services Aragon Institute have
initiated a programme to
detect situations of
vulnerability and to prevent
abuse against children. They
have been targeting different
fields since 2000 (school,
leisure time, social services),
informing and motivating
professionals on their role in
detection and prevention and
promoting co-ordinated
actions on the part of the
different institutions.
tertiary level: prevention that takes place after a problem has occurred, to remedy the
effects, or to avoid it happening again:
– Early diagnosis of the violent situation
– Proper inter-disciplinary services to ensure medical treatment, care, counselling, man-
agement and support of victims/families (!)
– Reintegration in a safe and empowering community/school
– More appropriate child protection laws and child-friendly courts
Prevention activities can be directed at different plans, namely: individual, family, com-
munity, regional, national and international. Secondary prevention targeting families of
children with disabilities is complex, as the family and non family patterns which need
analysing are complex themselves.
Prevention strategies should be carefully chosen and match the mission, the policy and
the resources of the promoter and as far as possible, be synergical with the prevention
and intervention strategies of other actors.
Appropriate prevention will produce important, long term and lasting benefits of a dif-
ferent nature, both for the (potential) victims and for society as a whole. Any cost bene-
fit analysis in social policies should take this into account.
Forms of prevention
Public Awareness Activities
Public awareness activities have the potential to reach diverse community audiences,
including parents and prospective parents, children, and other community members.
Public education efforts can achieve a variety of goals with regard to the extent, causes
and consequences of violence, namely: raising sensibility, improving knowledge, chang-
ing attitudes and modifying behaviour (!).
Media strategies are embraced as relatively non-intrusive options for getting the pre-
vention message across and reaching large numbers of people. Through the media,
communities are able to promote healthy parental practices, child safety skills, and pro-
tocols for reporting suspected maltreatment.
Family Resource Centres
Often through the use of participative methods, family resource centres aim to develop
specific services that meet the needs of the members of the community. Family-orient-
ed intervention aimed at changing parental styles and practices (decreasing the levels
of negative parental methods) and at improving intra-family relationships (closeness,
emotional cohesion, communication abilities) can effectively reduce the risk of antiso-
cial behaviour and violence.
Family resource centres may provide all of the following: parental skill training, drop-in
facilities, home visiting, job training, substance abuse prevention, violence prevention,
services for children with special needs, mental health or family counselling, child care,
literacy programmes, respite and crisis care services, assistance with basic economic
needs, and housing.
19
Section 3 ||| Prevention
18
Section 3 ||| Prevention
!The Family Meeting
Point in Zaragoza is a meeting
point co-ordinated by the City
Council and Aragon
government, with the
collaboration of other national
organisations and institutions. It
aims to assist those children
from families in a state of
crisis, where there are parents
who are going through a
separation, divorce or
annulment process, and where
there are families at risk of a
dysfunctional relationship
between parents and child. The
care of the child is provided by
a multi based professional
team which not only works
together with the Justice
Department, but also with the
parents to reinforce both their
parental skills and the
communication between them.
Home Visiting Programmes
These programmes consist of trained personnel visiting parents and children at their
homes to provide them with information, offer support, provide training on parental skills,
collaborate in the development of safe home environments and encourage linking to
community services.
There should be at least one visit during the child’s first two years of life, but the pro-
gramme may have been initiated during pregnancy and may continue after the child’s
second birthday. Long term programmes are generally more effective then short term
ones (!).
Programmes may be accompanied by the provision of day care, parent group meetings
for support and/or instruction, transportation and other services.
Parent Education Programmes and Parent (Peer)
Support Groups
Parents should not be left alone to care for their children. Work with parents includes
accepting disability, encouraging parental attachment and promoting good parenthood.
Parent Education Programmes typically aim to strengthen family protective factors.
These programmes address issues such as age-appropriate child development skills
and milestones, positive play and interaction between parents and children, locating and
accessing community services and support (!).
Parent (peer) support groups may offer important opportunities to communicate and to
share experiences and information.
Skills-Based Curricula for Children
Schools and social service organisations in local communities might offer skills-based
curricula to teach children safety and protection skills. They can include general con-
cepts such as assertive behaviour, sex education, decision-making skills and communi-
cation skills that children can use in everyday situations. All typically use interactive
methods. Most of these programmes focus their efforts on preventing child sexual abuse
and teaching children to distinguish appropriate touching from inappropriate touching.
Respite and Crisis Care Programmes
Respite care services provide help and care for children who have disabilities, chronic
or terminal illnesses, who are in danger of or who have experienced maltreatment. These
services may also be planned on an emergency basis. Crisis care is provided for chil-
dren when the family finds itself in severely stressed conditions.
They also provide different support services for families, including referrals to other pro-
grammes, counselling, case management, meals, transportation, social activities, lodg-
ing, medication, personal care, and assistance with day to day activities (!).
Both respite and crisis care programmes may involve other family members, friends,
neighbours, community recreation programmes, child or dependent care providers or
centres, domestic sanitary aid, family resource centres, community human service
providers and respite or crisis care agencies.
!Since 1965, the Greek
Institute of Child Health, a
private rights organisation, has
been promoting prevention,
public health, research and
educational intervention
through its various
departments (Social
Psychiatry, Family Relations,
Education, etc.). The staff
members are professionals
ranging from social workers,
psychologists, lawyers and
medics to psychiatrists. The
target audience is broad
based : professionals,
organisations, community,
families and children.
!Cerci Estremoz is a
Portuguese Institution from
Fenacerci which has
developed and created an
Early Intervention Programme
for children from 0 to 6 years
old and their families. The
programme aims to empower
families to deal with the
disability of their children and
offers resources and provides
networking services. Risk
factors related to the family
situation are indicated, and as
far as possible tackled in
collaboration with the families,
in order to avoid them
becoming precipitating
factors.
!The Greek Ombudsman
in an independent Authority
comprising five Departments
(Human Rights, Health and
Social Welfare, Quality of Life,
State-Citizen Relations,
Children's Rights). Since 1998,
the professionals working in
the Department of Children's
Rights have been visiting
schools and distributing
printed materials regarding
Greek legislation and the UN
Convention of the Rights of
the Child, and organising
meetings with children in their
own environment to make
them aware of their own
needs and to encourage them
to express themselves.
Awareness raising
programmes for parents and
professionals are the next in
line to be activated.
!In 2000 AIAS
Bologna, opened a centre
where children with
disabilities and parents come
to play. Educators and music
therapists propose play
activities especially devised
for each participant, while
parents can observe and note
which activities appear to
their children to be the most
attractive and stimulating for
them as well as reinforcing
for their communication skills.
This space also aims to be a
meeting point for parents, a
place for discussion and
confrontation among
themselves and where they
can find useful information
and support for the
development of positive
parental skills.
•As a priority in successful child maltreatment prevention, the needs of the family have
to be met at different levels (individual/parental, physical/psychological and so on).
Families must be put in the right condition to fulfil their fundamental role in the child’s
development. Prevention should build on family strength, exploiting their per-
sonal, parental and social resources. Families must be helped to discover and realise
their abilities as parents and as individuals (!).
•Co-operative and mutually supportive relationships between parents and
agencies and institutions responsible for the physical and psychological well being
of the child (e.g. schools, health services etc.) are to be encouraged, as they will increase
the efficiency of any intervention aiming at prevention. Intervention should be carried out
through active listening and understanding of the parents’ situation and be as much as
possible agreed upon in order for it to be perceived as concrete support. (!).
Associations and social co-operatives should be aware that even professionals in the
institutional network often do not know how to deal with the issue of domestic violence.
Only very few assistance and care providing institutions have adopted a code of prac-
tice regarding the prevention of violence.
•Empowering children means recognising their right to explore their potentials/poten-
tialities and providing them with the necessary skills to enhance them. Training and edu-
cational programmes must develop and reinforce communication, interaction and
action abilities, both in family and non-family contexts. Children must be taught to
become aware of their needs and feelings (e.g., sex education training) and of the prop-
er way to express them. This will facilitate intervention aiming at physical, social and
emotional support.
•Associations and other private organisations must encourage the development of a
network of relevant stakeholders and decide a role in it which best suits their mission
and competence. Such networks are typically made up of different public institutions
holding formal responsibility for the child’s well being and private non profit oriented
organisations representing families’ and children’s interests. The network’s aims and
the roles and responsibilities of the participating institutions and organisations must be
clear to all.
•Both public services and private organisations must promote an active prevention pol-
icy targeting their human resources, including selection, training and supervision pro-
cedures. There must be training especially for operators and volunteers working with
children and families in order for them to acquire and consolidate technical and rela-
tional skills, covering cognitive, organisational and emotional contents. Valid methods
of observation of child and family characteristics, interaction and behaviour need to be
taught.
•Prevention strategy should include awareness raising activities. The general pub-
lic needs to know the impact of the problem and to become aware of the context of
maltreatment in which children with disabilities can find themselves. The raising of
awareness concerning the risk of maltreatment of children with disability should be
transversally integrated into normal education, professional training and institutional
practice.
•Organisations should use their political power to defend the rights of children with
disabilities and to obtain appropriate legislation, intervention and support for their mem-
bers and others.
21
Section 3 ||| Prevention
20
Section 3 ||| Prevention
Cornerstones for prevention strategies
Developing prevention strategies means carefully defining the problem to be tackled,
the aims to be achieved, the activities to be undertaken and the expected results. The
following “cornerstones” will be helpful for any organisation that directly intends to
address the issue of domestic violence against children with disabilities or that intends
to encourage public services and institutions to do so.
Methodological issues
•To know and to understand the problem, its “whys” and “hows”, and its implications for
children with disability is the first step towards and a prerequisite for choosing a pre-
vention strategy. Accurate data and uniform definitions about child maltreatment
represent the basis for the planning of interventions.
•As prevention is a process aiming at change, promoters should plan and monitor the
process and the effects of their activities. Given the complexity of the issues and their
emotional impact, these effects are not always easy to predict. Organisations planning
an internal discussion should choose a careful strategy and guarantee professional sup-
port if necessary. Where prevention activities may lead to a higher demand for servic-
es, sufficient resources to cover these needs over a longer period must be available.
•Prevention is a process which includes different phases: detection, intervention and fol-
low up. Some fundamental qualities of this process are: appropriate timing (pre-
vention should be planned as early as possible), flexibility (prevention and intervention
should change according to the needs of both child and family), objectiveness (inter-
vention should be based on specific and detailed signals of risk and effectiveness and
must be monitored and evaluated), contextualisation (prevention should take into
account the context and its complexity in terms of the main players and their relation-
ships).
•Prevention strategies should focus on both reducing risk factors and strengthening
protective factors. Effectiveness can be increased if prevention embraces multi-level
interventions that simultaneously address risk and protective factors from different
domains.
•Prevention (as well as intervention) should refer to a clear strategy and ideally follow
a multi-disciplinary, integrated and co-ordinated approach. Therefore profes-
sionals working in different areas, namely, health, justice, social work, education and
special education, should work together sharing common goals and a common vision
of prevention. It is essential that they should communicate well and meticulously with
each other (!).
Issues related to the various stakeholders
•Associations and other private organisations wanting to prevent domestic vio-
lence must first of all work on themselves and be aware of their role during all phas-
es of prevention: in collecting signals, in deciding an intervention strategy and in direct-
ing it. Spaces and moments for dialogue and the sharing of ideas, of evaluation and
modification of the prevention/intervention projects must be formalised within the organ-
isation. This will encourage establishing a common language and reduce the ambigui-
ty of meanings and interpretations, which often cause non taking of responsibility and
delegation. These spaces should be opened to families with the aim of involving them.
!CISAP is an Italian
Consortium which has
promoted the project
"Maltreating, maltreated and
social network". The target
audience comprises families
of children from age 0-6
years, paediatricians, social
service operators, teachers,
judges, schools, police and
voluntary service operators.
Professionals have been
trained to work in networks
within the framework of the
project, and share information
and interventions. An
agreement protocol has been
elaborated between local
services specifying formats for
defining and carrying out
detection and intervention
actions. The protocol and a
handbook have been published
to communicate the project
results and for the use of
professionals.
!The Portuguese
Association for Developmental
Disorders and Autism(APPDA)
is a non profit organisation
which has created a project
for empowering families and
individuals to develop and
improve communication skills
and assertive behaviour, since
expressing feelings and
thoughts in a functional way
drastically reduces the risk of
violence and increases the
quality of life.
!The AIAS Bologna
"Zerosei Anni" project for
children from 0 to 6 years old
with disabilities provides home
support for parents. Educators
and home assistants care for
children with disabilities at
home: their intervention is
decided and jointly co-
ordinated by AIAS and social
or health agencies. These
agencies are in continuous
contact with families, in order
to monitor their needs.
Moreover, AIAS receives staff
observations and updated
reports of facts relating to the
child and his/her family. This
joint monitoring allows the
intervention to be flexible and
tailored to each family's and
child's needs.
2322
Note to the reader
The text of this booklet is the result of a collective writing process and not the sum of individual contributions.
Within the framework of the Childhood, Disability & Violence project the partner organisations have been involved
in literature research, the collection of cases of violence against children with disabilities and good practice in pre-
vention. Various experts, representatives of institutions and colleagues from target audience representing organi-
sations have been interviewed and the issues raised by the project have been discussed within the organisations.
The cases reported are based on real stories, but names, places and situations have been altered to protect the
privacy of the individuals involved. The examples of good practice have been chosen to be functional in the text
and don’t exclude the existence of other high quality prevention initiatives.
For more details, please read the full project report, available on the web site: www.aiasbo.it/daphne
For further consultation
•http://www.who.int/violence_injury_prevention/violence/neglect/en/
•http://www.unhchr.ch/html/menu2/6/crc/
•http://www.ualberta.ca/~jpdasddc/abuse/
•http://www.nspcc.org.uk/html/home/needadvice/protectingdisabledchildren.htm
•http://www.securityworld.com/library/retirement/abuseofthedisabled.html
•http://nccanch.acf.hhs.gov/pubs/prevenres/focus.cfm
•http://www.aiasbo.it/daphne for the full project report and more web links.
Bibliography
•Asociacion de Desarrollo Comunitario en Areas de Aragon and Instituto Aragones de Servicios Sociales, "El mal-
trato infantil", 2003.
•Bonnier C., Nassogne MC, and Evrard P. "Outcome and Prognosis of Whiplash Shaken Infant Syndrome: Late
Consequences After a Symptom-Free Interval". Developmental Medicine and Child Neurology, 1995; 37 (11):
943-956.
•DSM IV, The Diagnostic and Statistical Manual of Mental Disorders 4th ed., American Psychiatric Association,
1994.
•Sobsey, D. "Violence and abuse in the lives of people with disabilities: The end of silent acceptance?". Baltimore,
MD: Paul H. Brookes Publishing Co., 1994.
•Sobsey D, Randall W, and Parrila RK, "Gender differences in abused children with and without disabilities". Child
Abuse Neglect, 1997, Aug; 21 (8): 707-20.
•Sobsey D., "Exceptionality, Education, and Maltreatment". Exceptionality, 2002; 10 (1): 29-46.
•Sullivan PM and Knutson JF, "The association Between child maltreatment and disabilities in a hospital-based
epidemiological study". Child Abuse Neglect, 1998, Apr; 22(4): 271-288.
•Sullivan PM and Knutson JF, "Maltreatment and disabilities: a population-based epidemiological study". Child
Abuse Neglect, 2000/a, Oct; 24 (10): 1257-73.
•Sullivan PM and Knutson JF, "The prevalence of disabilities and maltreatment among runaway children". Child
Abuse Neglect, 2000/b, Oct; 24 (10): 1275-88.
•Tomison AM, "Exploring family violence: Links between child maltreatment and domestic violence". Issues in child
abuse and prevention, National Child Protection, 2000; Clearinghouse Issues Paper, AIFS, No. 13.
•United Nations, Convention on the Rights of the Child, 1989.
Full text: http://www.unhchr.ch/html/menu2/6/crc/treaties/crc.htm
•World Health Organisation.
For more information: http://www.who.int/violence_injury_prevention/violence/neglect/en/
Sources
Risk factors
Parent or caregiver factors
Mental illness, personality disorders, suicide attempts and psycho-
logical suffering
Lack of parental skills
Low stress coping skills, self-esteem and self-expectancy
Authoritative parental style
History of maltreatment during childhood
Substance abuse
Inaccurate knowledge about child development needs and
processes
Unrealistic and unmet expectations
History of behaviour disorders and aggressiveness
Adolescents without family support
High stress levels
Social isolation
Lower economic status
Single parenthood
Unwanted pregnancy
Inadequate prenatal care
Low family adaptation to disability
Refusal of offered support and resources
Family factors
Difficult and chaotic household ( family size and density)
Unsafe housing and inadequate day care
Marital conflicts and domestic violence
Stressful life events, parental stress and emotional distress
Unemployment and financial discomfort
Low cultural level
Social isolation
Greater tolerance for harsh discipline strategies and verbal aggres-
sion (e.g., hitting)
Child factors
Physical, cognitive, emotional disabilities
Premature birth and low birth-weight
Special needs, frequent hospitalisations
Behavioural disorders (e.g., aggressiveness, hyperactivity, sleep dis-
orders etc.) or high demands for caring
Inability to understand, report the abuse and escape from it
Environmental factors
Non-existent, un-enforced child protection laws
Decreased value of children (minority, disabled, gender)
Poverty and unemployment
Social isolation
Less material and emotional support
Dangerous neighbourhoods
High social acceptability of violence
Promotion of violence in cultural norms
Media violence
Protective factors
Parent or caregiver factors
Psychological well-being
High stress coping skills, self-esteem and self-expectancy
Acceptation of disability, recognition of both limits and potentialities
of child
Accurate knowledge about child development needs and process-
es
Social and family support
Adequate maternal and parental health care
During childhood, positive relationship with at least one adult
Family factors
Safe, ordered housing and adequate day-care
Stable and supportive relationship with partner
Ability to cope with the challenges and adapt to the changes which
naturally characterise family life cycles
Job and financial comfort
Social support
Positive educational strategies (e.g., positive feedback etc.)
Child factors
Ability to interact with others and express his/her feelings
Sex education during adolescence
Integration in social contexts (e.g. school)
Behaviour and attention stability
Environmental factors
Child rights can not be disregarded
Enforced child protection laws
Increased value of children
Welfare and employment
Social support network
Interagency and multi-professional social network
Safe neighbourhoods
Social unacceptability of violence
Cultural norms and media promotion against violence
Appendix 1
24
Indicators of child
maltreatment
Child physical indicators: refer to physical
lesions, health, nutrition and appearance
Injuries or marks on the skin
Burns
Bites
Fractures
Signs of trauma
Psychomotor delay
Neglected aspect
Low weight
Neglected infections
Dirtiness
Apathy and lack of vitality
Clinical signs of intoxication
Child behavioural indicators: behavioural
characteristics and child personality traits
Child is wary of adults and interacts with suspiciousness
Child seems to be afraid of his/her parents
Tendency to isolation and retirement
Lack of participation in play and group activities
Lack of differentiated reactions towards unknown people
Aggressiveness, antisocial behaviour
Destructiveness
Hyperviglilance
Unexpected sexual behaviour
Need to call attention
Psychological disturbances (anorexia, insomnia, enuresis, irritability,
somatisations, bullying)
Failure at school
Parent indicators: behaviour, language
and attitudes
Implausible explanation of what has happened
Discrepancy of symptoms referred by the mother, clinical history and
clinical evaluation evidence
Family history of child maltreatment
Dysfunctional family relationships
Delay in obtaining medical assistance for the child
Absence of worry about the child, his/her appearance, physical and
emotional needs
Overprotectiveness
Jealousy
Negative ideas and attitudes towards the child (devaluation, dis-
dain)
Severe discipline strategies
Appendix 2
